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.