Tuesday, May 25, 2010

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!

Friday, May 21, 2010

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.

Friday, May 14, 2010

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!

Sunday, May 9, 2010

Mother's Day - South Asian Edition

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*

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 :)

Friday, May 7, 2010

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.

Saturday, May 1, 2010

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.