In need of some Jamz

I think I need to start working out (on a regular basis) again. I don’t particularly enjoy working out. When I’m in a gym, I feel like I’m going nowhere (literally) fast. But as I get older, I’m actually feeling my metabolism slow down to a being a little faster than a speeding slug. And my love of chocolate, baked goods and carbs in general seems to increase exponentially day by day. I’m also not ready to confront my family history of heart attacks and diabetes anytime in the next couple of decades because I know I’d be a terribly non-compliant patient. Since I REFUSE to deprive myself of delicious foods, I have realized that I must pay for this by working out. So dear fellow bloggers – I need your help. The only way I can keep up with high paced workouts is by music. So tell me your favourite songs to work out to or just madly dance around to! I’m open to pretty much all genres of music – 70s, 80s, 90s, top 40s, dance, pop, rock, hip hop – anything goes as long as it’s got a good beat and it’s fast! Looking forward to all your suggestions and not hating my work outs :)

Epidurals are for Chicks

While working on a paper during the night shift, I got a patient complaining of severe 10/10 back pain. The guy was wearing a brace, grimacing, could barely walk, the works. I did my standard assessment, got him changed into a gown and called the doc over. The doctor ordered some toradol and dilaudid which I proceeded to give to the patient. After I had given him the meds I told him that I would reassess him in about half an hour. In half an hour, he still was not a happy customer because when I came back into his room, he was ranting on about how the doctors just expect everything to be fixed with a pill (at 0230 that pretty much is the only thing that can be done). I asked him what he would like done because he was given some pretty high doses of pain medication to which he replied, “can’t you give me like a needle in my back nerves so I don’t feel anything?” “Like an epidural?” I asked. “Fuck that shit! That shit is for chicks! I don’t want no fucking epidural bullshit! I want a needle to make the pain go away!” He didn’t take too kindly to my explanation nor did he view the IM injection of toradol as a needle to make the pain go away. I went back to working on my paper because that seemed like the only rational thing to do. And the guy walked out of the department without his back brace.

I’m a Terrible Blogger

I’ve been an awful blogger lately. I’ve started to take some classes and I feel like I’ve completely lost the ability to manage different areas of my life. I'm running out of clean scrubs, the cat is constantly annoyed about her food bowl not being filled on time and my hair is getting greasier and greasier. I suppose I'll save money on shampoo. Whereas in my younger days, I could memorize a textbook in a week (if I didn’t procrastinate) now I can barely get through an abstract without my eyes growing dull with boredom. I’ve started writing some promising posts only to abandon them halfway through to go out for a coffee. I have to get through a few assignments and then it’s going to be back to blogging as usual.

In the meantime, I’ve been going through all the comments about my grandmother passing away and my adventures about head-butting with a doctor about patient care and I wanted to thank everyone for their kind words and thoughts. I’m happy to say that management actually had my back on this one. I’d love to give out more details but privacy, confidentiality, blah blah blah won’t allow me to.

Now that I’ve run out of every conceivable activity to do before doing my readings (including blogging), I must get back so that I can keep a few days homework free!

My grandmother passed away today. She was an incredibly beautiful lady inside and out. I hope in my old age I become as serene and loving as she was throughout her life. I miss her.

Annie from 5C*

It was many and many a year ago
In a unit called 5C
That a nurse there worked whom you may now
As Annie who hates ED
And this nurse she worked with no other thoughtThan to refuse patients from me

I was a nurse and she was a nurse,
In emerg and floor 5C
But we fought with a fight that lasted all night
I and Annie of floor 5C
With adversity that the other staff,
Avoided her and me

And this is the reason that long ago
Back down in emergency,
I yelled, “for crying out loud”,
Get this patient up to floor 5C
So that I can get Spencer in,
To clear the waiting room, indefinitely

Management, not half so happy at their desk
Were badgering annoyingly,
Yes! That was the reason (as RNs know, in emerg and floor 5C),
That I went transferring to 5C tonight,
Upsetting and angering my foe Annie.

But when the shift ends and when we all leave,
With some who are older than we –
Mostly as tired as me,
Head on home wishing to drink lots of whiskey
While Annie and I bitched side by side
About emerg and floor 5C


Have a frightfully fantastic Halloween whether you're at work or not!
*Both Annie and Floor 5C are FICTIONAL

Going Beyond the Scope of Practice – The Follow Up

I haven’t been doing so well since last week. I’ve been worried about how I would deal with that doc when I’d see him, how my manager would react, how far up the food chain this incident would have to travel and how exactly I would compose my words so I wouldn’t sound like a bumbling idiot. I’m not very articulate when stressed. I was scheduled to work four nights, two of which had to be with that doctor. He completely ignored me for both of the nights which as we all know is highly conducive to patient care (note sarcasm). I approached him on the second night to offer an olive branch but my efforts were in vain. “Next time I talk to you, it will be with our bosses” were the only words he said to me in two nights. Not kicking him was an overwhelming exercise in self-control. I’m still waiting for an official meeting with my manager but she sent me an email saying that she’s reviewing the chart along with the doctor’s manager and so far my documentation is air tight. Some of my MD buddies have also sent me very supportive emails. This is a relief but I’m still waiting to see what happens next.

Now that I’ve had some time to process the incident, I’m really pissed. I have a feeling that I’m going to have to do BS workshop about scope of practice, regulatory standards and how to properly escalate issues up the all knowing hierarchy. I already know all that. I don’t want to imagine what would have happened if I was wrong. What I want to know is if the doc will get a slap on the wrist or actually be made to examine his own issues that nearly led to a volvulus being missed if an x-ray wasn’t ordered by a nurse who hasn’t been alive as long as he’s been practicing medicine. I hate being a team player with a person who thinks his word is law and is in dire need of accepting a retirement package.

Going Beyond Scope of Practice

For the past two years, I’ve seen plenty of patients come in complaining of abdominal pain. Following their treatments has revealed causes as diverse as bad sushi for lunch to peritonitis to stab wounds. Each patient has had a particular look that seems to be unique to their symptoms. Paying attention to these looks and storing them away in the back of my mind has allowed for the development of a fairly accurate sixth sense. Usually I’m right and this is the case with pretty much every clinician out there. This is why when I tell my MD colleagues that a patient looks sick, they usually try to see my patient more quickly, or at least give me the green light to order labs and imaging outside of my medical directives.

However, some docs are not as accommodating and I tread a little more carefully around them. I make sure to get them to sign orders that they’ve verbally approved before proceeding because I’ve been burned pretty badly in the past. I suppose it was just one of those days in which I had to be extra careful with the doc when the charge nurse told me that she was bringing a fairly sick looking woman complaining of generalized abdominal pain. The kicker – she makes hypochondriacs look sane. I’ve personally dealt with this woman many, many, MANY times. She now knows my full ethnic sounding name in all of its guttural glory – and can actually pronounce it. One look at her and I knew she didn’t look like her usual self. She looked pale, clammy and was doubled over in pain. While she was changing into a gown, I tracked down the doctor and told him about this woman. I was very curtly dismissed from his office with a vague comment on how he needs to catch up on his charting before dealing with another drug seeker. I went back to draw some baseline labs and put in two large bore PIVs after palpating her very distended belly. She really didn’t look right despite her vitals being normal. I went back to the doctor and asked if he wanted me to draw blood cultures or a serum lactate but again I was shooed away.
After what seemed like an excruciatingly long wait, the doctor sauntered into her room, gave her a prescription for naprosyn and told her to go home. “Listen dear”, he said while squinting to read my name tag despite the fact I’ve worked with him for two years, “I’ve been a doctor longer than you’ve been alive and I’ve known this patient for at least five years. She’s looking for attention and I’m not in the mood to indulge her so get rid of her now”. He quickly disappeared around the hallway before I had a chance to raise my objections. The thing is that I didn’t have an objective leg to stand on – her routine labs were pretty much the same as all the other times she had come in. She had a very mildly elevated white cell count and her temperature was a degree higher than usual, though she was not febrile. But I couldn’t dismiss how distended her belly was. Even though the evening doctor’s shift was going to end in 45 minutes, I pled my case to her but since she’s quite new and doesn’t want to ruffle too many feathers, she declined to reassess this patient. The patient was now crying which usually elicits no response from me but this time I could not shake the feeling that something was very wrong with her. I talked to the charge nurse and I went back to the other doctor to plead my case. I knew that if I was wrong I wouldn’t be able to live this down for a long time but my concern was fringed with panic.

The patient’s doctor overheard me pleading my case to the younger doctor which unleashed an impressive rant about his judgment being repeatedly disrespected by nurses and doctors who hadn’t been alive as long as he was a doctor. The younger doctor reluctantly left while mouthing an apology for not being able to help. I was stuck. The charge nurse was stuck. We knew that she needed further management but without orders, we legally cannot proceed further. I had done everything in my scope of practice. When I went back a third time to this doctor, his entire office seemed to be dripping with contempt at my concerns. The fringes of panic began to take over my judgment and I ordered an abdominal x-ray. I had done everything in the scope of my practice when I stepped outside of its bounds into the wild west of nursing practice. I knew that the doctor could get my ass kicked if I was wrong. But the panic persisted.

The woman came back from her x-ray looking devoid of colour. I went back to the doctor a fourth time and told him what I did. I felt like a child being severely reprimanded for painting the walls with crayons because he spent an eternity ignoring my pleas to look at her x-ray while he yelled at me. Finally, I grabbed the keyboard from him and opened the x-ray myself. One look at it and he was silenced. She had a massive bowel obstruction.

Two days later, I found out that the obstruction was caused by sigmoid volvulus and was taken to the OR half an hour after my shift ended. Her lactate was obscenely elevated.

So many times I tell myself that I had done everything within the scope of my practice. Yet if I had stuck to the limits of my scope, the woman could have died. Since then I manage to overhear some disparaging remarks like, ‘if she wanted to manage the care herself why didn’t she just go to med school?’ The truth is I have no desire to go to med school. I often try to push the scope of my practice to its breaking point while feeling like a bottom dwelling cog in the medical machinery in order to do right by my patients. By no means do I plan on ordering imaging tests and labs outside my medical directives a regular part of my practice but in this instance I felt completely backed into a corner. I have seen many skilled and experienced nurses go beyond the scope of their practice for their patients because they feel that it is the only way to get things done. I’m far too hesitant to do that because I have no one to back me up if I’m wrong outside of my scope. And yet, it can be very frustrating and limiting to know that my influence on patient care is negligible no matter how hard I advocate on their behalf.

The Ten Grossest Stories... Ever?

Today I realized just how much nursing has desensitized me because I was looking forward to being shaken and revolted to my core by reading these stories. Instead, I just chuckled and shook my head as I was reminded of shifts past. But I hope these manage to offend and sicken you :) And if you have stories that can outgross these, tell me!

10 of the Grossest Stories You'll Ever Read

Documentation Funnies

26 y/o male presenting with approximately 5cm lac to dorsal surface of right hand near thumb from xacto knife approx 2 hours ago while installing carpeting. Moderate bleeding from laceration. Patient unable to flex/extend thumb.

Pain scale – “It feels like my wife sliced my hand open with a hot knife and my girlfriend poured vinegar into it”.

That descriptor conveys an incredible depth of emotion that leaves 10/10 looking rather bland.

Great Moments in WTF-ery

An assumed to be good humoured middle aged woman with cellulitis comes into fast track and has the bad luck to get Dr. Kick ‘Em Out as her doctor just as I was leaving for a much deserved pee break. She was his patient less than 24 hours ago and was joking about how quickly he goes through patients – almost as if he kicks them out. She came back because she lost her prescription for antibiotics. She waits patiently for her turn and expresses her apologies for wasting the staff’s time. She didn’t waste anyone’s time. Stuff happens. Dr. Kick ‘Em Out writes an incomplete prescription and sends her on her merry way. By this time, I had returned from what could be considered one of the best pees of my life to find that the patient is nowhere to be found inside the fast track area but her chart loomed ominously on my desk. The doc tells me he has discharged the patient but will finish the chart later (snort – yeah right). Just then I receive a call from the in hospital pharmacy stating that the prescription was incomplete and the patient was on her way back to the emergency department. Instead of getting her re-registered, I thought I would get the doctor to finish writing her prescription and she could (once again) be on her merry way. Sure enough, I see the patient talking to the triage nurse and I bring her right back while I jokingly said, “I guess the doc kicked you out huh?” What followed was like an unsuspecting slap and left me wondering, ‘W. T. Effin. F’? She went on a 10 minute rant which included the following gems; “You have no right talking to me the way you just did! Is that ‘dark humour’*? Do you think your ‘dark humour’ is funny? Do you think that’s funny? You nurses are so cavalier about your attitudes to life and death, it’s disgusting! You’re a mean woman who deserves nothing less than to have your nursing license taken away and be publically shamed into learning how to speak to CUSTOMERS of the Canadian health care system! How dare YOU assume that the doctor would have kicked ME out? I’m a patient and I have rights which cannot be violated especially by the likes of an uncaring nurse like you! I’m going to be sending a letter of complaint to patient relations about your unseemly behaviour!” I wonder if he also gave her a script for Zyprexa.

*Each time she said dark humour, she used very dramatic finger quoties. I should have won an Oscar for being able to keep a straight face for those 10 minutes.

Flying with Ativan Man

There are times in the year when I am a shit magnet. Shit seems to fly at me from the most random and unexpected encounters. I’ve made peace with this aspect of my karma but there are still days when I have no choice but to shake my head and laugh at my weird luck. I was reminiscing on my shit magnet status with a few folks when I remembered Ativan Man. Ativan Man is someone I was seated beside when I was flying out for my vaykay. He was so normal as to be almost invisible. This is, until the airplane’s ‘fasten your seatbelt’ sign dinged on and the engines started to rev up. That’s when Ativan Man suddenly got extremely anxious and started digging madly through his bag while hyperventilating. I tried to ignore this for as long as I could but it was clear that I would have to intervene. I very reluctantly turned to Ativan Man and asked, “ummm what’s up?” “Need my pills! I NEED MY PILLS WE’RE FLYING!!!!!!!!!!” was his response. Only with my luck could I have been seated next to a man afraid of flying who didn’t pre-medicate. Before I could get another word in he started to wildly gesticulate towards his hands complaining that they were becoming numb and tingly which elicited the unwanted attention of the next row. People thought that I was travelling with him while I tried to avert their gaze and wished that I could sink to the bottom of my seat and stay there forever – or at least until the plane landed. But I put on my nurse face (again reluctantly) and told him to start deep breathing while I found the conspicuous orange container in his bag. I opened the bottle for him and he took half a tablet. I encouraged him to take the other half. He did. Twenty minutes after take-off, he was snoring with his mouth open and turned towards me. I landed six hours later with my hair smelling like old coffee breath.

Independent Practice (From TorontoEmerg)

I was going to write something about nursing practice but (as usual) I got distracted, started reading other blogs when I came across TorontoEmerg's post about independent nursing practice. She has written about the topic far more eloquently than I can manage so I'm just going to provide a link to her extremely thought provoking post. Enjoy!

Back to Work but In Better Spirits

When I wrote my last blog post, I was feeling rather indifferent about my work and nursing in general. The last thing I wanted to think about was work or anything related. Even blogging seemed depressing because I didn’t want to revisit work related stories. All in all, it was high time for a break! Since then, I’ve done a little travelling, got a new cat and have been busy trying to house train her and enrolled myself in some continuing ed courses. I had a serious talk with my boss about moving into other sections of the department to which she reluctantly agreed. Now (as clichéd as it sounds) I’m once again looking forward to work (or at least not dreading it as much) and I have some blog posts brewing which should be posted up within the next couple of days. It's good to be back!

The Workplace Blahs

Lately I haven’t been feeling as engaged with my work as I have been in the past. Each day feels like it blends into the other with the same staff members arguing over petty things and the same patients (literally – the frequent fliers have been flying in a lot more frequently recently) presenting with the same complaints. It’s humbling and frustrating to know that sometimes no matter how above and beyond my duties I go, I’m quickly brought back down to problems that just can’t be solved. It’s tiring arguing with the same floor about patient transfers, it’s tiring to have to turn away the same drug seeker three times in one shift. It’s tiring to have to work harder and faster to maintain patient flow while being left on the back burner by the rest of the department. Perhaps its summer and seeing people enjoying warm evenings while I trek it inside to the windowless department is getting to me more than I thought but things are definitely feeling – stagnant. I don’t know if I need a new challenge, more responsibilities or another job. I suppose for now I have to get dressed, go to work and give viciously dirty looks to the resident who complained to my charge nurse that I need to “smile more”.

This post is most certainly a downer so I’ll leave a link to Hyperbole and a Half. This site has been providing me with life sustaining laughs during night shifts!

Learning Plans and Yearly Performance Reviews

Nursing school was full of learning plans. Learning plans for a class, learning plans for clinical placements and learning plans for group projects. Now that I’m in the ‘real world’, learning plans continue to be made and revised each year – usually when there’s a yearly performance review scheduled by the manager. I’m somewhat torn on the issue of learning plans. On the one hand, I think they’re a useless waste of time. I always end up scrambling to write down something that might fit with learning goals that were written when I had no idea what I was getting into. However, they can also serve as a checklist for the things that I did want to learn and/or improve upon as well as documentation of ongoing professional development. Invariably, when I meet with my manager this year, I will have to justify why I didn’t accomplish a single thing on my learning plan written last year when I was not allowed to work in certain areas of the department that I do now. That is not to say that my professional growth has stagnated for the entire year – I have taken several courses, applied that learning to my work and have informally learned much more than can be summarized in 150 words. On top of all that, I have never been a very details oriented person. I like to have a general outline with lots of room for maneuvering and improvising because in my experience, things hardly ever go as planned. I won’t be too upset if I learned things that I didn’t know before instead of learning what was strictly written on my learning plan. Regardless of how I feel, I will be wasting a beautiful afternoon writing inane BS to appease the powers that be. And the real kicker – my yearly review is scheduled on the last effin hour of my shift before I scramble to get to the airport!!

Signature Drink at Last!

I was recently in a dilly of a pickle because I decided to give up my Starbucks addiction and could not think of alternatives. After a month or so of experimenting with different beverages during my shifts, I have to say that lychee pear green tea with honey has slowly earned its way into my heart and most importantly, my gut! I like that if it’s a mind numbingly hot, humid and hazy day, I can throw in some ice cubes and voila – it’s ICED lychee pear green tea! A close second for night shifts is a strawberry banana smoothie with pineapple juice – keeps me filled up and keeps the night shift bloaties at bay. The great thing is that I can buy a huge box of tea and honey and leave it at work so it’s a lot cheaper. The smoothie requires some planning ahead but worth the time. I’ll still visit Starbucks and get myself an iced coffee occasionally but our relationship has cooled considerably. My beverage choices are earning me some strange looks from the diehard caffeine addicts but the peace and calm of my GI system is far too great for me to care. Oh how grand my troubles have been…

Being Called into the Boss’ Office

I walk into my assigned area, take report and miss having my signature drink (which I still have not managed to replace just yet) and start providing excellent care (ie – making sure all is well and my peeps are breathing) when my boss asks me to come into her office. After visiting the loo to make sure I don’t wet my scrub pants in her office, I resign myself to my fate and prepare to accept whatever happens. I sat down shivering and realized that two of the charge nurses were in her office as well. Then I was really happy that I peed before. My boss’ steely gaze settled on the chocolate stain on my scrub pant and then she told me, “congrats Maha, you have the best attendance record of this year” and then she shooed me away to a violently vomiting patient. I was bewildered and then saddened because I didn’t get a gold star and a raise. What an odd day.

When the Patient Makes the Wrong Choice...

Informed consent is a tricky thing sometimes. The doctor and nurse can explain the risks in minute detail that would bore even the most meticulous of medical ethicists but the patient Just. Doesn’t. Get. It. The most visceral feeling is to smack them upside the head until they start making sense but that doesn’t work because that might precipitate a head injury and create more work and the nursing licensing bodies frown upon that sort of behaviour. So what is a nurse to do when the patient has multiple facial fractures from a bar fight and a broken arm that needs to be surgically repaired but won’t stay for highly necessary treatment because “I’m not sitting around here all day bitch”? He stayed for a head CT and there weren’t any signs of cranial bleeding – asshat was probably his baseline. Many nurses and doctors told him and his girlfriend that he would be at risk for some pretty serious complications if he didn’t allow himself to be treated but our advice was not appreciated. He ripped out his IV and left. Much of the staff (including myself) was happy to let him rot away somewhere when he kicked a chair as he left the department and expend our efforts and energy on patients who wanted our help. “Whatever, we told him the risks, he’s a big boy” was the common phrase heard for the next half hour or so. Now this particular patient was informed of pretty much everything that could go wrong with him but he still chose to leave. After I calmed down and decreased the use of highly creative expletives, I actually felt pretty bad about he was treated. True, he pissed the entire department off and his attitude left a LOT to be desired. But I feel that had I held onto my ‘nice nurse persona’ a little longer, he might have agreed to stay and be treated – or at least revealed why he was so unwilling to stay despite his serious injuries. It was hard to watch him leave the department knowing that he would be in a lot of pain and face many complications but he was aware of the risks. I still wonder though if he was truly listening or heard, “blah blah blah you suck stay and get better” from us. Hopefully he did come back and get treatment even if he was a jerk.

Giving Up and Moving On

No, I’m not quitting my job. However, what I did quit is my outrageous addiction to Starbucks’ grande lattes. What motivated me to quit was not the delicious and soothing caffeinated warmth that my beloved lattes provided me with, but rather their after effects. I begin to realize that my lattes were the gastronomic equivalent of frenemies. I was constantly nauseated, bloated, gassy and sometimes if the combination of espresso to dairy products was in perfect proportions... well, let’s just say gastric distress cannot be ignored. My warm hug from a Starbucks cup was beginning to feel like an uncomfortably tight embrace. Since giving up Starbucks, I feel like I’ve given up a part of my identity. How can I manage to be the same nurse without a Starbucks cup affixed to my hand? It would be like Dr Grumpy sans Diet Coke. It just doesn’t seem right. Having said that, it has only been 6 weeks – in terms of Starbucks sobriety, I’m still in the infancy stage. Maybe I’ll have one bad shift or a sleepless night and I’ll go running towards the shiny green logo. But because I’ve made my attempt to give up my Starbucks dependency somewhat public, I feel obligated to continue to tread the path of less caffeine for as long as possible. Plus, my wallet is beginning to feel a bit heavier and I’m liking that better than my midsection doing the same!

The question remains, what should be my new (and healthier) signature beverage?

Secrets

I’ve probably treated hundreds of patients and each one of them tells me their secrets. Some people tell me their secrets inadvertently and some tell me for the relief of confession. Some secrets are relatively benign and others have been carefully hidden for decades to preserve a family. Some secrets are spoken aloud and some are revealed when a patient is changed into a drab hospital gown. Some secrets hit me like a ton of bricks and it can take days to recover (if not weeks) and some just float gently away from me. There is no rhyme or reason to what I remember and what I forget. Sometimes I find myself thinking about the elderly patient who has been abused and neglected by her family for an unforgivable amount of time just as I start to think about the teenager who does not want to call his mom because he knows he was not allowed to get his tongue pierced, much less infected. At the end of the day it can be sobering to think about the countless people who have entrusted me with their secrets and how on bad days acknowledging those secrets can feel so mechanical.

I’m BACK!

My little stay-cation was wonderful in every aspect except in length. However, I went back to work in great spirits, ready to embody compassion of such magnitude that Mother Teresa would stop to admire me. That lasted about two hours into my first shift. I was first met by Dr. Lazy who asked if I could write down the patient’s history on the chart and he’d sign it so he could do some online shopping instead. Yeaahhh no. A few hours after, I was accosted by a drug seeker who asked me to convince the doctor about the merits of writing her a prescription for a year’s supply of narcotics including fentanyl patches. Her reasoning was that if she had a huge supply of narcotics she wouldn’t come bugging us quite as often which would make all of our lives easier. I was quite impressed that she realized her behaviour was annoying to the staff but my fondness withered away when I snapped back into my senses and had to tell her that it wasn’t going to happen in this lifetime. Oh drug seekers how you manage to provide me anecdotes I can use for bitching! It’s good to be back!

Mini Vakay

Despite my bodily flexibility rivaling rigor mortis at times (actually between the hours of 0300-0600), I have to pat myself on the back and congratulate myself for my gravity defying scheduling acrobatics. By switching some shifts around, giving a couple away and bribing and weaseling my way through admin (food counts as bribes), I managed to get almost a week off from work. Freedom has been embracing me in its glorious warmth (or the 35C temperature) and I have been doing everything from cleaning my house, enjoying nature and not getting pissed off at people who congregate in herds and then move slower than a speeding slug, catching up on non-medical themed literature and watching many hours of Glee. Freedom also explains the dearth of blogging this week but I’ll be back next week in fighting form! Enjoy all of your days whether you’re working on not!

Pelvic Exam Fails

I don’t have substantial statistical data to present on this blog post, but I’m fairly certain that pelvic exams don’t top of the 100 most fun things to do lists for most women, however, they end up being necessary for one reason or another. As a female nurse chaperoning male doctors while they perform a pelvic exam, my level of awkwardness has ranged from acceptable to “please let me die now so that I never have to relive this moment again”. Because I’m a glutton for punishment (and this topic was the one being discussed during my last night shift), I decided to recall the three most horrifying pelvic exams I’ve had to witness and post them up for your entertainment!

Pelvic exam fail 1
A woman with 10/10 suprapubic pain is thoroughly nervous, grimacing and probably wishing she could crawl up into a hole somewhere and die. Dr. Hotshot comes in, starts spewing his spiel about the process and proceeds to do a bimanual which makes the patient tear up with pain. Dr. Hotshot says, “Sorry dear, I’ve got huge fingers” FAIL!

Pelvic exam fail 2
A woman with half the colour wheel on her face shows up and loudly announces “My p**** is leaking fishy cottage cheese and my stomach hurts so bad”. Just my luck that Sizzlin’ Samuel was the resident who ended up doing the pelvic exam and I got to be the lucky nurse chaperoning. He gently explained what he was going to do and as far as pelvic exams go, he was very professional. Just when he started doing a bimanual exam, the patient looks at me and asks, “Honey has he ever done this to you and you liked it too?” We both ran out of the room after that declaring that exam to be a FAIL!

Pelvic exam fail 3
A 2 day post partum woman who gave birth at home presented with fevers, chills and crampy lower abdominal pain and intermittent spotting. Retained products of conception was the primary suspect which led her to the gyne stretcher. The husband looked somewhat stoned but at 0200 I don’t exactly look lucid either. The speculum is inside the woman, the doctor is cleaning out some clots and the patient has her eyes closed, probably counting down to the time when her entire ordeal is over when the husband says, “Baby lemme take a picture of this” as he inches towards the doctor with his iPhone. The patient got freaked out, kicked her husband in the face and the gyne tray (with clots and tissue) went flying across the room. FAIL!

A Sudden Emptiness

I recently found that three of the most challenging, difficult and at times sorely despised frequent fliers of my ER died within the last two weeks from narcotic overdoses. They were all young – in their early to mid-twenties. I have dealt with all three of them at some point during the past two years. Two of them tried to punch me (and missed). The other one threatened to find me and kill me as I was leaving work. I remember having my lost my temper at all of them and had kicked them all out of the department at one point or another. When I saw their names on the tracking board, I felt my spirit dampen because I just did not have it in me to deal with their drama for one more night after so many difficult and emotionally draining encounters.

And yet I am a little saddened by their passing. Their deaths were inevitable given their lifestyle. In fact, every time they survived an overdose, we were surprised that they managed to cheat death again. I don’t feel grief exactly. My life hasn’t changed in any significant way. But I still wonder who will mourn for them? I never saw them with friends or family members. It’s sobering to acknowledge that for all those times I wished I would never deal with them again, I now know I never will.

You Are Such a Jerk!

Dr. Condescending was working the night shift when I got a patient who was experiencing some mild shortness of breath. The man had an extensive respiratory history and had recently been diagnosed with CHF. The department was swamped and I was transferring patients to the floor left, right and centre. The new patient had blood work done, ECG done, was hooked up to the monitor, had a rhythm strip printed and had a foley catheter inserted because I knew he’d be getting lasix and someone would want accurate ins and outs.

I sit back at the desk huffing and puffing (getting over a cold – again) when the good doctor sits down in the chair beside me and asks, “Are you nurses not printing out old records and ordering chest x-rays any longer? Because I just had to sit down in front of the computer, log in under my name, look through his old chart, print it off and then had to order the x-ray. This took me 14 minutes to do and in those 14 minutes I could have seen 3 patients. I’m sure you nurses are busy but it’s your job to maintain the patient flow in the department right dear?”

Being polite with Dr. Condescending doesn’t work. It seems that he makes it his life’s work to make newbie nurses hate their jobs. He used to provoke a whole lot of anxiety for me. Not anymore. Why? Because I have come to realize that his snobbery is beyond my control. He’s a jerk – plain and simple. He’s a jerk to the nurses, he’s a jerk to the patients, he’s a jerk to the residents and med students, he’s a jerk to the other staff doctors and he’s even a jerk to the coffee guy.

He continued to look at me expectantly waiting for an answer and when none came his way, he started to ask again. Not being in the mood to listen to his baseless ranting (again), I said quite a few things to him that I probably shouldn’t attempt to rewrite. His lame response in kind was to suggest that I was likely experiencing monthly hormonal fluctuations while my student for the shift looked on in horror. He then gave the charge nurse $5 to “order something for the poor hungry nurses”. His money was promptly returned while the rest of the department enjoyed a ridiculously delicious pot luck dinner. He of course criticized the food as being far too pedestrian for his sophisticated tastes.

If there’s any moral to the story, it’s that no matter how hard I work, there will be a jerk willing to dismiss everything I’ve done. But he will be the lone voice that will be silenced by many of my patients and friends cheering me on!

Mother's Day - South Asian Edition

1999
Me: Happy mother’s day! *hands over a bunch of flowers*
Mom: Thank you dear. They are lovely. But you know what would make me happier? You learning to cook something decent so I don’t have to slave over the bloody stove all day long!
Me: Keep dreaming!
Mom: *SMACK*

2010
Me: Happy mother’s day! *hands over a bunch of flowers and snacks*
Mom: Thank you dear. This is lovely. But you know what would me happier? You settling down with a nice man and giving me some grandbabies so I have something to live for in my old age!
Me: I don’t have to settle down with a nice boy to give you grandbabies Ma!
Mom: *SMACK*

Happy mother’s day to everyone :)

I Have to Get Home

Another week gone by and another set of shifts done and over with. The theme of complaints this week was “I didn’t know it was going to take so long – I have a baby/young child/sick husband/dog/cat/parrot/gerbil that I can’t leave alone for much longer. How much longer do I have to wait?” For the most part I’m quite sympathetic to caregivers who are worried about their loved ones left at home and I do try to get them seen faster IF possible but I can’t be rushing doctors out of resus rooms just so someone can get the script they want and go along their merry way. A particularly memorable family asked me, “Don’t you people care that my sister has a baby at home?” Well, unless the baby is in imminent danger at home, I actually don’t care. Everyone would rather be elsewhere but guess what? For one reason or another they’re in emergency and everyone will get seen when it’s their turn.

Yet another guy with positive peritoneal signs and excruciating pain kept ringing the call bell (how they manage to find the call bell tucked away in a crevice and not the bathroom right in front of them is truly a mind-boggling phenomenon) and asking how much longer he would have to stay because he has a dog and a cat at home that he can’t leave alone for much longer. I don’t know what part of “you may need surgery tonight” was not sinking in. I offered to call his friends on his behalf to get them to take care of his pets but all he wanted to do was to leave before the night was over. Sorry buddy – not gonna happen unless you understand that you might DIE if you leave the hospital.

Maybe I’m becoming a little bit more crusty as time goes on, but I’m finding it harder and harder not to snap at people who think that the ER is their personal drive thru and I’m personally responsible for the volume, accuity and wait times of the ER.

Do Unto Others...

Recently I was having lunch with my friend and the conversation drifted towards each others’ health and the results of my recent blood work which showed that my hemoglobin is on the lower side of normal. “Dude, I’ve transfused people with hemoglobin that low”, she said when I revealed the number. My doctor was a little worried and suggested a transfusion but I turned her offer down without even thinking about it. I told her that I couldn’t bear the thought of having to wait in an emergency department for hours to get a unit of blood. Besides, I was asymptomatic and somewhat proud of my ghostly pallor. “I promise I’ll take my iron more regularly and eat more spinach” and with that I skipped out of there and headed to my favourite Thai restaurant. Needless to say my doctor was a little pissed. When I told my fellow nurse about the whole ordeal she said that were she in my shoes, she would also have rejected the offer but not for the same reasons. “The thought of some stranger’s blood going in you is just gross – I better be on my death bed to consider that option”. I wholeheartedly agreed with her.

A few days after that, I was in the nursing lounge on my break when the conversation drifted towards life saving medical interventions and how much each one of us would personally tolerate.

We talked about how far each of us would be willing to go if we were competent and had the capacity to consent. Some of us wanted everything and the kitchen sink thrown at us while others (well, just me) settled on being heavily sedated and opting for organ donation in case of life threatening injury with little to no chance of recovery. We also talked about procedures and interventions that were necessary to stop further deterioration in a patient’s condition. Of course my favourite loud mouthed nurse had to bring up my refusal to get a transfusion into the conversation.

“I don’t get it! You have no religious objection to getting a blood transfusion but you’re letting an irrational get in the way of something that will probably make you feel better almost instantly! What’s wrong with you child?” asked one of my favourite doctors.

“It’s gross!” (food coma was setting in and capacity for rational argument was decreasing exponentially).

“So you think all the people who get blood transfusions are also gross?”

“NO! I just find it repulsive if that were to happen to me but I’ll do it if I really REALLY have to!”

“If I were your doctor I wouldn’t let you leave until you consented! I think you’re being very silly and a unit of packed red cells would probably make you feel a lot better very quickly”.

“But I haven’t had any symptoms associated with low hemoglobin and I’m taking my iron pills so I see no need to get a transfusion just to boost up my lab values”.

Inevitably, my break ended but it got me thinking – how often do we push aside patient autonomy for percieved beneficence? How often do we manage to ‘convince’ our patients to do what we think is right for them or their families despite their beliefs? If my brief conversations with my friends and colleagues yielded such varied view points and disagreements, how would someone who has never had any experience with health care know what the right thing to do would be? Would I be upset with a patient who rejects an important procedure due to an ‘irrational’ fear or plain old disgust? I hate to say it, but there have been times I have been a little annoyed. Back in nursing school, I figured “Do unto others as you would have them do unto you” would be a good rule to follow but now that I can’t even decide what I have others do to me, I find it harder and harder to argue with families when they want something that I may not agree with.

Differentials of Disorganized Thinking in the Elderly

The charge nurse tells me that she is going to be bringing me an odd, but otherwise lovely patient presenting with some mild complain which could potentially be serious. I get the said patient into a room, I do the workup, she gets seen by a doctor – the usual stuff. But I begin to notice that there is something that’s just not quite right. The patient is extremely cooperative and polite but the stories just don’t add up. A conversation about health history quickly turns into one about the time the patient tried to kill 20 prison guards to rescue her favourite radio from being dismantled by giant cacti shaped monsters and how if I look hard enough at the old man in the suture room, he looks like Jesus (despite the old man being Sikh). Utterly confused (and somewhat frightened), I decide that further blood work would likely be necessary and an order for a urine tox screen wouldn’t be a bad idea. When the patient (surprisingly) lets me draw more blood and willingly gives a urine sample, I didn’t know if I should be thankful that getting samples was such a peaceful affair (even though the patient tried to fit herself under the stretcher when I was finished getting the blood samples) or if I should have reached for oars to paddle through shit creek if the patient decided to go postal. Looking back, I should not have tried so hard to convince my favourite doctor to order a head CT but rather, I should have expected grandma to be having an awesome acid trip as the police showed up to charge her with possession and dealing of cocaine – again.

When Nurses Get Sick

Sick Nurse – Guys, I think I’m going to have to throw in the towel and go home. I just threw up again and I’m beginning to spike a fever.

Charge nurse – Sure thing hon. I’ll pull one of the float nurses to cover your area. Feel better soon.

Patient’s family member at nursing station – What kind of nonsense is this? We get sick, we come to the hospital. You get sick, you go home!

Sick Nurse – I prefer bowing to the porcelain gods in my own bathroom.

Bet They Didn’t Teach That in Med School

At around 2330, a man walks into a fairly dead department and tells the triage nurse that he has a burn on his chest that he would like to have seen by a doctor. He gets triaged to me so I do the usual chart set up, help him get changed into a hospital gown and start my assessment. Turns out, he was waxing his chest. However, he didn’t realize that the wax was hot enough to not only stick to his hair but literally start cooking the skin underneath the hair. He could not pull the wax strip off because he would tear out a piece of chest as well as the hair so he came in for help. The staff doctor was speechless and stumped and said he would be right back. I told him not to worry his pretty little head off about it and get me some mineral oil instead. The wax was oil soluble so I kept dabbing mineral oil onto it and dissolving it piece by piece until all of it melted away. When the staff doctor asked me how I knew what to do, I shrugged it off - not out of humility - but because I wasn’t about to tell him that I’ve had my legs waxed for more than a decade with the same stuff. The man then got a little dressing, some unconventional discharge teaching and a card to my auntie’s salon!

Too Much Facetime

To say that the past 10 days or so have been insane is an understatement. Common sense abandons me as I get offered overtime and I agree to work a lot more than what’s considered healthy. Although yesterday’s payday was great, I’m not going to be taking on so many shifts for quite a while. For one thing, I really need my downtime to unwind and get myself back on track. I also need a break from my colleagues. This is not to say that I don’t like the people that I work with (because for the most part, I know how lucky I am to have such a supportive team) but after spending almost 10 days with the same group of people, I am in dire need of solitude. I work in a department that has a lot of youngish staff who are die hard partiers and I find myself frequently declining invitations to drinks and clubbing. Having exhausted my partying days a long time ago and not being much of a drinker, I’m starting to feel stressed out by frequently having to defend why I just want to stay on my favourite couch reading a good book. Since I live quite far from where I work, I have to commute and after 12 hours, it pretty much drains the last bit of my resolve to maintain an alert level of consciousness. Commuting on my days off feels like a special sort of nightmare. Lastly, I also like to catch up with friends and family who don’t work with me. This is not to say that I never accept an invitation for a night out here and there, but I feel like I need some distance between my coworkers and other aspects of my (mostly boring) life without coming off as a snob.

What say you readers? Is this an unjustified rant from a social recluse or do I have a point?

A Few Funnies

I foolishly switched around some shifts that look good on paper but have scrambled my brain because of rapid turnovers between nights and days. This has clearly decreased my ability to write a proper blog post (temporarily) but has had no effect on my ability to enjoy nursing (and non-nursing) funnies. In the spirit of sharing, her e are a few that made me chuckle and I hope they do the same for you.

------------------------------------------------------------------------------------------------

Tasty Morsels
Due to a labour shortage, three cannibals were hired as orderlies in a busy hospital. During orientation, the director of human resources said, “You’re all part of the team now. You can earn good money here and you can go to the cafeteria for something to eat. So please don’t trouble any of the other employees.” The cannibals promised.

Four weeks later the boss returned and said, “You’re all working very hard, and I’m very satisfied with all of you. However, one of our nurses have disappeared. Do any of you know what happened to her?” The cannibals all shook their heads no. After the director left, the leader of the cannibals said to the others, “which one of you morons ate the nurse?”

A hand raised reluctantly, to which the leader of the cannibals replied, “You IDIOT!” For four months we’ve been eating hospital administrators and no one noticed a thing and then you had to go and eat a nurse!”


The Meaning of Politics
A little boy goes to his dad and asks, “What is Politics?”

Dad says, “Well son, let me try to explain it this way:
I bring in the money for the family, so call me Capitalism. Your mother is the administrator of the money, so we call her the Government. We are here to take care of your needs, so we will call you the People. The nanny, we will consider her the Working Class. And your baby brother, we will call him the Future. Now think about that and see if it makes sense.”

So the little boy goes off to bed thinking about what Dad has said. Later that night, he hears his baby brother crying, so he gets up to check on him. He finds that the baby has severely soiled his diaper.

So the little boy goes to his parent’s room and finds his mother asleep. Not wanting to wake her, he goes to the nanny’s room. Finding the door locked, he peeks in the keyhole and sees his father in bed with the nanny. He gives up and goes back to bed.

The next morning, the little boy say’s to his father, “Dad, I think I understand the concept of politics now.”

The father says, “Good, son, tell me in your own words what you think politics is all about.”

The little boy replies, “As Capitalism screws the working class, the people go ignored by the sleeping government and the future is full of shit”.

------------------------------------------------------------------------------------------------

A Simple Prayer
Lord help me to be careful of the toes I step on today as they may be connected to the ass that I may have to kiss tomorrow.

------------------------------------------------------------------------------------------------

Epitaph on the tombstone of a hypochondriac
Told you it was real.

------------------------------------------------------------------------------------------------

The Doctor’s Funeral
A cardiologist died and his coffin sits in front of a huge heart. When the pastor finished with his sermon and after everyone said their goodbyes, the heart opened, the coffin rolled inside, and the heart closed. What a beautiful way to go.

Just at that moment, one of the mourners started laughing. The guy next to him asked, “Why are you laughing?”

“I was thinking about my own funeral” the man replied. “What’s so funny about that?”

“I’m a gynecologist”.

The proctologist next to him fainted.

Goodbye to the Sweetest Furriest Friend

A few days ago my sweet little kitty passed away from complications of pneumonia. He was almost 18 years old and he was loved by me and my family for almost 9 of those years. I’ll miss Kitty’s whiskered face looking up eagerly at me when I cook with meat demanding to have a taste. I’ll also miss him gently following me throughout the backyard when I plant my flowers. When I see birds flying around, I’ll miss kitty chasing them and getting frustrated at not being able to catch them. Kitty will be missed every time I go to the kitchen and see the empty spot where stray kibbles were spread around his food bowl. I’ll miss kitty drinking water from the money plant container because he liked flavor infused water. It will be sad to not see kitty sleeping on his favourite corner of the bed or sneaking into laundry baskets. But most of all, I’ll miss kitty every time I need to smush something furry, warm and loving just because he was furry, warm and loving. RIP little kitty – we were lucky to have such a sweet, loving, friendly and gentle creature in our lives. You are loved a whole lot and now you'll be missed a whole lot ;(

What. The. Fuck?

I felt compelled to write the actual words out because I’m just THAT pissed off. First, the Dutch moron who tried to get a nurse branded incompetent for not providing a happy ending with her visits and now this banner on an English bus of a sexy nurse advertising the route to a hospital.

There are many feminist theories that can much more eloquently dissect this piece of shit ad apart, but I’ll stick to good ol’ fashioned rage. It angers me to no extent when I have to listen to idiotic drivel about how nursing is a ‘sexy’ profession. I sure as hell don’t feel sexy when I’m trying to stick a foley catheter in a 250+ lb violent drunk to get a sample for a urine tox screen. There’s absolutely NOTHING sexy about trying to provide care to people who are too sick to speak for themselves and are terrified of institutions. Sexy is not a variable in question when a nurse has to go to the corner and sob out of utter despair because someone dies unexpectedly. When I was studying my ass off for exams and writing papers like a demon on meth, I most certainly did not think, “Hot damn, all this studying is gonna make me one sexy nurse!” And I highly doubt that (most) patients are thinking, “dayum baby stop talking sexy to me” when I’m asking about the frequency and consistency of their purulent anal discharge. Ads like these do nothing to promote nursing as a profession that has dedicated itself to caring for those who can’t care for themselves and has long been marginalized.

An Educational Post

Self explanatory, really.

Spousal Abuse

A particularly vicious strain of gastro is making its rounds in my ER and most of the staff has taken time off to puke and shit their guts out. Charming, I know. Being one of the only healthy staff members left, I got a call asking if I’d be willing to work two overtime shifts. I readily agreed, not because I LOooOoOove my work, but because student loans are a bitch to pay back. The first shift was a regular run of the mill shift – drug seekers, some legitimately sick people, more drug seekers and a few hypochondriacs. The second shift was pretty much the same except for when a 70 something year old gentleman was brought to the ER. I greatly respect the particular triage nurse who was working that day so when he said that he suspected elder abuse, I was immediately alarmed. Sure enough, the man had multiple bruises in various stages of healing and he had the demeanor of a man humiliated and frightened. I called the social worker to assess the situation and tried to stay by his side in case he wanted to talk. An hour later, his wife arrived and asked if she could have a few moments alone with him. And that’s when I heard swearing that would make a sailor blush. Turns out his wife had caught him watching porn multiple times and this time she used his cane to beat him rather than her bare fists of fury. Most days it’s a privilege to be to able to peek inside other’s lives so closely – other days, I’m just left shaking my head as I head towards my latte.

When the ER Watches the Gold Medal Hockey Game

Working 14 hours sucks mighty hard, especially after 3 day shifts. But what a shift it was, especially when the Canada vs. US game was on. When the US scored 20 seconds before the game was supposed to end, monitors started to show skipped beats. The atmosphere transformed from one of the joy to absolute devastation. That is until Canada scored the winning goal in overtime! The entire department – doctors, nurses, paramedics, patients, security, house-keeping staff and police officers erupted into screaming cheers and broke out singing O Canada. Even Dr. Crusty was all smiles. What a game – it was enough to lift me out of my sleep deprived foul mood for the rest of the shift!

A Man's Touch

There are some days working with the elderly can be physically exhausting. Some folk are in advanced stages of dementia and contractures and they (rightly so) become scared and lash out at nurses. Then there are those elderly folk that have to be manipulated at certain angles so tubes and needles can be effectively shoved into them. And then there are those folk whose minds are sharp as tacks and will say something with enough shock value to make seasoned veterans blush profusely. I had just one such patient. Let’s call her Betty. She was a 94 year old lady from home accompanied by her daughter presenting with urinary retention and a whole lot of pre-existing urogynecological problems. Betty needed a foley catheter. Betty was VERY difficult to catheterize but she did the best she could to help us out. 4 nurses tried and failed. Two of the female staff emergency doctors tried and failed. An eager medical student tried and left the room with failure following her. Finally, we had to admit defeat and call in the urologist. One of the staff docs called the urologist and told him the sad story of Betty’s ever expanding bladder and within 10 minutes the urologist came down to see what the big fuss was about. He swaggered into Betty’s room, introduced himself and explained what he was about to do. Betty was mighty uncomfortable and said “do whatever the hell you’ve got to do” and that’s exactly what the urologist did. Dr. Urologist shortly declared the catheter to be in place and draining a whole lot of urine. To express her gratitude to the urologist, Betty did not say thank you, but rather, “I needed a man’s touch to open up” and winked at him lasciviously. Dr. Urologist quickly fled the room while turning various shades of purple. Us women-folk were a little peeved that she didn’t tell us of her requirements but vowed that we would forever call the urologist for his manly touch!

Amateur Photography Endeavours

Tools of the Trade


Fuel


Winter Sunset

It’s Raining Forms

I was recently teaching a nursing student who asked me what I hated most about the profession. At the time I answered, “waking up early”. It’s true – there is nothing I hate more than waking up before the sun has risen and shivering my ass off while I walk to the train station. Words can’t describe how much I hate early mornings. In fact, I refuse to schedule anything before 1400. I make no secret of the fact that I’m loathe to early morning activities so I was rather irked that my corporate education day was scheduled bright and early at 0800 in which management tried to indoctrinate me and fellow am haters into the society for filling out useless forms – twice. We sat there for a solid five hours listening to mindless drones drone on mindlessly about the necessity of filling out both online and paper forms for incident reporting, blood glucose monitoring, blood transfusion monitoring, order entry, narcotic records and a whole lot of other stuff. Suffice it to say, that my brain activity declined to nearly zero half way through that session.

When I got back to work the next time (for a bloody day shift too), the new documentation policies were in place. I tried to keep up with the mountain of paperwork while trying to provide meaningful care but inevitably fell behind because there are only 12 hours in a shift and my bladder and declining blood sugar levels can only be ignored for so long. On my way home, I felt quite awful for ignoring some of my patients and rushing them because I had to fill out pointless forms which were designed for the sole purpose of tormenting nurses. The following week, a staff meeting for the nurses was called by the nurse clinician and the manager to inquire about the ‘barriers’ that prevented us from filling out the forms. It was nice knowing that I wasn’t the only one being entombed by one useless form after another but having woken up early (again!), my brain to mouth filter was malfunctioning. I suggested that perhaps she should hire an army of form fillers so that the useless form gods are appeased with the sacrifice of millions of trees while patient care remains unchanged. Amidst the chuckles and snorts of my coworkers, I noticed that the manager and clinician were not amused but I still stand by my suggestion.

The next time I get asked what I hate most about nursing, I will now modify my answer to waking up early to fill out forms – twice!

Papa-Paparazzi

I recently bought a new camera and I’m becoming a little obsessed with photographing anything that catches my eye. Granted, I have no talent (yet) but I do know when NOT to start snapping away like a lunatic tripping on crack laced short bread cookies. For example, I would not start taking pictures if I had signed myself into an ER to be seen by a doctor. It’s bad enough when I’m trying to compete with cell phones but when patients become irate and start taking pictures of ‘lazy nurses’ and empty stretchers with their camera phones to prove that their care is being purposely delayed, well, that just makes me angry. Recently, I’ve had to tell a patient to stop taking pictures of patients occupying stretchers because it’s obviously disrespectful and violates confidentiality. After all who wants to be photographed by a stranger while ill? He didn’t seem to think that I had a point and retorted that he was going to share his pictures with the local news channel to highlight how badly he was being treated. Sasha, the Russian ex-prison guard current bad-ass security guard was called to assist. The formerly irate and now thoroughly petrified patient promptly handed over his cell phone to him and watched while the pictures were deleted. The phone was returned after the patient was discharged and was walking out the door. Yet another unhappy customer tried to take pictures of a few nurses and doctors at the nursing station because we were far too ‘social’, meaning we weren’t paying attention to her demands for more ice chips. She accused us of being lazy good-for-nothings who were ignoring patients to chat about weekend plans and demanded to know exactly what we were talking about. What didn’t cross her mind was that the lazy nurses and good-for-nothing doctors could actually have been trying to sort through a very complicated social and medical history of a fairly sick patient and she was not privy to that information. Again, Sasha had to step in.

When I wrote my last post, I was furious that people could be so vicious for not experiencing instant gratification. Today, I’m just annoyed. I really do sympathize with patients who are getting frustrated at having to wait and wait and wait and wait and wait and then wait some more. It sucks. I get it. I try my best to keep my patients updated on a regular basis and explain how care is managed in an emergency department. However, I can’t wrap my head around the fact that some people actually think it’s acceptable to take pictures of staff and patients and demanding information that they have no right to possess to bully their way into getting the attention that they feel is owed to them. A picture maybe worth a thousand words, but without context and perspective those words can be incredibly harmful. There is a reason that confidentiality has to be respected and it’s not only to destroy entitled morons’ dreams of becoming the next big name in photojournalism.

Left Alone to Lick My Wounds

A particularly caustic nurse once told me that in her 20+ years of practice, she has learned the true role of the nurse is to take abuse while maintaining a smile for 12 hours. At the time I thought that she needed to retire and do so within the hour but after last week’s emotionally grueling shifts, I don’t think she was that far off from the truth. Every racist epithet was thrown at me, every combination of insults regarding my appearance, my intelligence, my competence and my worth as a human being were shouted from the triumvirate of asshole families in exam rooms 5, 6 and 7. Why would that be? Because they could not understand why they were ‘forced’ to wait so long to see the doctor when their elderly relatives were in various stages of ‘dying’. Calling in security seemed to incense them further since one of the family members was supposedly someone ‘important’. They only seemed to settle down once the doctor saw them and of course by then they were all as happy as pigs in shit. By the end of that shift, I was seething in raw white hot inarticulate rage because I was forced to endure those families’ abuse. And for what? I did everything within my scope of practice, I spent an exhausting amount of time with all of those entitled bastards about what the emergency department process entails for the patient, the role of the nurse and the physician in a patient’s care but it was all in vain. The charge nurse and I walked into their rooms to have them berate us in the most demeaning ways possible because they could not disimpact their heads from their asses to open their eyes to the reality that in an overwhelmed system, we were trying to provide the best care possible. Fuck trying to empathize with patients when they treat nurses like shit all because they feel that it’s their right to get whatever the fuck they want whenever they want.

As I write this, I’m still furious. Why is it that nurses have to put up with so much shit? Had I been working ANYWHERE ELSE, all three of those families would have been dragged out by the police but because they were ‘important’ and ‘sick’, I had to put up with those repulsive degenerates. Why is it that I would have been forced to attend some bullshit anger management class if I told them to go fuck themselves sideways with an IV pole right after I heard the supposedly dying patient call me a “dumb rag head bitch” because the blood pressure cuff was too tight? Why is it that my only outlet is to document thoroughly and write a lengthy email to my manager who’s just going to hold some idiotic meeting rehashing the same old policies about handling volatile patients? How the hell would my manager would understand exactly how viscerally humiliating racist slurs can be especially when she could never have experienced it herself? I don’t feel like the ‘better person’ for following the prescribed course of action. I feel completely powerless and incredibly angry because they got away scotch free while I’m left with no meaningful course of action. Now I get why nursing has such a huge problem with retention and it has nothing to do with changing a dirty diaper.

Quiz Time

Take out your pencils and put away your books and let’s take a quiz Dr. Grumpy style.

Question
You are a registered nurse employed at a nursing home. During lunch time, you notice that one of the elderly residents is making a strange hacking noise and appears to have progressive difficulty breathing. This particular resident has a history of dysphagia (difficulty swallowing), chronic obstructive lung disease and is easily distracted by external stimuli (such as other residents eating). Do you;

a) Check the mouth for possible sources of obstruction (such as food) and attempt to clear it.
b) Ignore your (much junior) colleague’s about checking the mouth of possible sources of obstruction.
c) Chide her for not finishing her meal
d) Panic, call EMS and have her transported to the local ED and repeatedly express your concerns over the patient’s falling oxygen levels as something beyond her baseline. Also emphasize concern about her recent diagnosis of a UTI.
e) Call her family and tell them that perhaps now is the time to see grandma and they better hurry.
f) b & d
g) b, d & e

If you chose answer g, you are correct. Bonus points if you were able to elaborate as to why EMS didn’t sense that something was amiss either.

Key learning summary: Some days, the only course of action at one’s disposal is to let head meet desk. Repeatedly.

When You're Afraid of Blood...

I recently had a patient brought to me from a nursing home for hip pain. The patient was quite heavy and because of the hip pain, which turned out to be broken, he was on the immobile side of mobility. Repositioning him was ideally a four person job but during a busy as hell day shift, I had to make do with only one nurse and some creative stretcher maneuvering. However, his son came in during the middle of the day to help out. This guy was amazing. He was a freaking bodybuilder (!!!!!) so he was a little stronger than me. He helped out with repositioning, changing, feeding and he was a very calming presence for his dad. So it came as a little surprise when he flat out refused to hold down his dad’s arm when I needed to resite an IV that went bad. “Uhh umm uhhh okay?” was my reply to his refusal. “Miss I’m like really afraid of blood! It’s just… so… so… RED!” I respect that so I told him not to worry as I went to grab another nurse to help me. I asked him if he wanted to stand outside the room. He stepped outside, but guilt and filial duty prompted him to come back into the room to help out just as his dad’s vein was cannulated with some blood escaping. I saw his face turn ashen and then he hit the ground with a loud thud. For a few brief seconds everyone was stunned into silence as we stared at the 6”5’ bodybuilder slumped on the ground. Luckily the nurse who was helping me had more sense than I did and rushed over to the son while I finished up with his dad’s IV. Ignoring a few bruises, the son was unharmed. “I told you I was afraid of blood miss”.

In the Same Room

Several shifts ago, I was assigned to an area with five rooms. In one of the rooms was a homeless man who was being treated for cellulitis and hyperglycemia. He was eventually discharged to a community care centre where home care nurses would take over. After the room was scrubbed clean, another patient was brought into the room. The second patient was a fairly well known celebrity. I thought that it was remarkable that two people with completely opposite socioeconomic backgrounds were treated in the same hospital, in the same room by the same team of doctors and nurses. The Canadian health care systems may have its problems, but it was nice to see it actually working as intended.

Critical Care

Today I felt heartbroken while listening to the news about Haiti on my break. It seems so remarkably unfair that the poorest nation in the western hemisphere must bear the brunt of such a horrible disaster. Please bloggers, donate generously to charities because the best thing we can do for now for the people of Haiti is to give money to reputable international aid organizations. Check out these links for more information.

The Red Cross – www.redcross.org
Oxfam International – www.oxfam.org
Doctors Without Borders – www.msf.ca
World Vision – www.worldvision.org

Also read Dr. D’s more eloquently written appeal to donate to Haiti and his time spent working their prior to becoming a doctor.

Top 10 Mortifying Ways to Die

A few days ago, I was wrapped up in my blankets trying to ward off the -27C wind chills. I wanted to socialize but the prospect of freezing my ass off (in a very literal way) prevented me from leaving the confines of my down blanketed couch. Compromising between complete anti-social behaviour and face-to-face interaction, I started to catch up with another fellow nurse on MSN. When two nurses who are sleep deprived and lean towards the odd side of normal, we come up with a list of top ten ways to die. The hilarity was far too much to keep to myself, so without any further ado, here is our list of the top 10 mortifying ways to die.

10. Having a vasovagal episode while taking a huge dump after being constipated for a week.

9. Getting hit by a car while streaking on the highway.

8. Electrocuting oneself with a vibrator.

7. Accidentally asphyxiating/hanging oneself while trying to achieve sexual gratification.

6. Hitting your head on the ceiling IV fluid hanger in the middle of a code.

5. Choking on the finish tape at the end of a marathon.

4. Getting hit by the Oscar Meyer car – in front of the nutritionist’s office.

3. Re-enacting a stunt from “Jackass”.

2. Being eaten by a bulimic wolf and then being barfed back out.

1. Falling headfirst into a bedpan full of C.diff and aspirating on it.


Got any other embarrassing ways to die?

Dear Residents

We have been working together for quite some time now and I hope you know that I’m your friend. I don’t mean that in a facetious or sarcastic way at all. I truly am your friend. I value your learning very much because one day you little doclings are going to grow up to treat me as well as my loved ones who are hovering around their 60s and beyond. I realize that despite all the orientations you will get from your seniors and attendings, navigating a unit, its protocols and its culture can be frustrating. Many of you turn to nurses to guide you through the noisy maze and while I can’t speak for every nurse, many of us are more than happy to help you through the process. Us nurses are also familiar with the attendings’ mood (swings) and their teaching styles so if for some reason you find that the head honcho is bitching at you for something mundane, we can probably guide you towards a safe exit. So in return I would greatly appreciate if you could please keep the following guidelines in mind:

1) Don’t page a nurse overhead stat to a patient’s room to deliver blankets and clean diapers. Especially if the nurse is another room doing a delicate procedure – like say, CPR.

2) Don’t order an esoteric combination of medications past the hour when the pharmacy closes down and we’re down to floor stock, especially when something simple would suffice. If you want to know whether or not a med is stocked, just ask!

3) If you sign up to see a patient, please ensure that you actually do see them. Patients tend to get irritated when they come to a hospital and are not assessed by a physician. They then take it out on the nurses, which makes everyone unhappy.

4) If a nurse is telling you that a licensed physician needs to administer a medication, writing “nurse may give ____” on the chart is not going to cut it. We all have our licenses to protect and we all like getting paid. It helps a lot with groceries and rent.

5) While we’re on the subject of writing appropriate orders, please do not write, “nurse may administer available narcotics until pain manageable”. I’m flattered that you value the nurses’ judgment so highly but narcotics are highly controlled substances which need clear orders to dispense. Also, see comment above about groceries and rent.

6) And yet another guideline for appropriate orders. If you’re in an area of the department in which patients are only brought into rooms for assessment, it is not appropriate to write, “patient may sleep in room”. If myself or another nurse actually followed that order, we would have our asses kicked from here to Australia and back with a steel toed boot for slowing down patient flow.

7) Please leave charts as you find them. As much as some of us might have liked scavenger hunts back in grade school, somehow the joy of hunting down a chart is just not the same thing.

8) If you’re in a patient’s room (especially one that is an isolation room), please do not ungown, wander the department and ask the nurse to obtain a set of vitals on the isolated patient. Patients who are isolated have their own fully stocked vital sign machines inside the room.

9) If you freeze up during your first code don’t feel bad. There are a lot of experienced nurses and doctors in the room. I guarantee everyone can sympathize. The sympathty ends however, if you start finger pointing and blaming.

10) Please and thank you always help when talking to anyone and everyone.

Follow these guidelines in any department on any rotation and I guarantee you’ll have a good (or at the very least, tolerable) relationship with the rest of the staff. I hope you enjoy your emergency rotation and if Crazy Carl is insisting that the key to survival lies in dismantling the IV pump, please order Haldol stat.

Your friend,

Maha

Ten Years

I have always been told that in order to go forward, one must examine the past. Inspired by the beautiful post over at Hope Dies Last, I thought that I too would begin the new year by reflecting on how I’ve changed over the past 10 years.

I rang in 2000 huddled with my friends around Lake Ontario in frigid weather watching fireworks and waiting for the big y2K shut down. I was on top of the world and free from every restriction because my family was in another country and I was almost finished with high school. I was whoever I wanted to be. I didn’t belong to anyone. That year I partied way too hard, spent too many nights out late and devoured every piece of literature I could get my hands on. Afterall, I would be a Pulitzer prize winning writer. I was half-heartedly trying to catch the eye of that special someone but wasn’t particularly disappointed when I lost interest after a while. I still kept partying though.

In 2001 I started my first year of university. I was overwhelmed and excited by all that had to be learned. I made lots of new friends, lost a lot of old ones, then couldn’t keep in touch with the new ones. Being overwhelmed by my parents’ concern for my future, I spent half the year locked up in the library. Unfortunately, it was the wrong half of the year I spent in the library. I completely fucked up my first year.

2002 was the year I had to convince my parents that I was never going to become a doctor. The ‘future’ was amorphous and frightening and I had no intention to discuss my lack of direction with anyone, let alone my father. I also had to convince my mother that I will probably never be the traditional south Asian woman she wanted me to be. I was a product of Canada and I had no ties to back home. I had no idea what I wanted to do or what I wanted to be. I was ready to quit school. I felt extraordinarily lonely. I spent a lot of time crying in the middle of the night.

In many ways 2003 was the spring of this decade. I found my niche in university, I found courses and professors that inspired me. I made friends that saw me through thick and thin. The humidity of the summer slowed time enough to let me focus on what I wanted to with my life. My hopes were high and my expectations higher. And I lived up to them.

I kept fighting with my parents in 2004. It was the last time I saw my grandfather before he passed away. I felt like shit for most of the year. I was working towards a masters degree I had no interest in pursuing. I fervently wished that time would slow down. I wished I picked a better major, a different school, a different life. I felt lost, directionless and purposeless once more. It’s also when I started to give nursing some serious consideration. I also took up a lot of bad habits – I gained a lot of weight.

I was supposed to graduate in 2005. Instead I took up a part time job, dropped a few courses and told my supervisor that I would not be applying to the master’s stream. One of my friends got married. I went to her wedding reception feeling like an immature child. She was my mother’s dream come true. A well educated lady in a beautiful sari on her wedding day who wanted to start her own family. I was happy for her, yet I resented her because she had the wisdom to realize that one’s background is a very large sphere of influence in life. Ties to one’s background and to one’s family are never really neatly severed.

2006 was a year of beginnings and endings. I graduated with my first degree in biology and two social science streams. Did I mention I was a tad indecisive? I said goodbye to some really good friends as they moved abroad and started their own lives. My sister and I spent our summer bitching about the poverty that seems to go hand in hand with being a student yet still managed to have a lot of fun as always. I started the accelerated nursing program. It slowly dawned on me how much responsibility I would have to shoulder. I wanted to quit. I got involved with a not so nice guy.

I didn’t quit nursing school in 2007. I trucked through some horrendous clinical placements. I put up with crappy preceptors. I learned to quickly recognize and bow to the healthcare hierarchy. My dad was convinced that I would change my mind and hand in applications for the master’s in biology program. It never happened. My sister put up with me rambling about drugs, pathophysiology and the cruelty of having to write so many papers. I lost a whole lot of weight – mostly through healthy means but there were some unhappy days that involved starving, a whole lot of caffeine and a few instances of binging and purging. I was strong, I was focused. I was determined. I felt weird when people started to ask how I lost so much weight and how much better I looked. I made incredible friends in nursing school (here’s looking at you G and J).

I graduated from nursing school and got hired in the ER in 2008 on a probationary basis. A part of me couldn’t believe that someone would be stupid enough to hire me right out of school and in an ER of all places. Mostly though, I was elated and incredibly thankful that someone was willing to give me a chance. I was going to be an EMERGENCY NURSE. I felt as if I had finally conquered a step towards truly growing up. Though I was at the bottom of the ladder, patients still looked to me for answers and guidance. I was scared shitless and the magnitude of responsibility felt overwhelming. I started blogging a lot more. My uncle sent me a text in the middle of a shift telling me that my grandfather had died of lymphoma. I spent my lunch crying in the bathroom. To my everlasting regret, I never made the trip back home to see him one last time and tell him how much he meant to me. I wish he could have seen me as a nurse.

I became a full-fledged staff nurse in early 2009. My learning increased exponentially by attending the school of hard (health care) knocks. I put a few extra letters next to my credentials in my CV. I’m amazed at how much I know and overwhelmed by how much I have yet to learn. I started to teach again, albeit as a nurse rather than tutoring kids in science and math. Despite my endless bitching (in this blog and to my wonderful sister), I remained incredibly thankful for having a job in which I can actually make a difference to someone sometime. My parents and I stopped fighting as much – we’re all too old for it now. My circadian rhythm has been effectively degraded into a cacophony of noise.