Call bells make me nervous

An Education (In Nursing)

2011-12-19T23:30:00.000-05:00

I decided on nursing after I realized that my first degree would not land me a job that I’d even remotely enjoy. However, I gained invaluable research and analytical skills that have served me well, and continue to do so, in my nursing career. I enrolled in an accelerated nursing program in which I could skip some electives and concentrate on core nursing courses. I bring this up because I recently finished preceptoring a nursing student and it was nothing short of a challenge. His lack of motivation was only matched by his creative excuses to justify his tardiness and absence from shifts. However, what really struck me was his absolute lack of research and math skills. I’m not talking about designing one’s own RCT in the midst of a code or solving a limit of a function as x approaches infinity but basic stuff like being able to look up the pathophysiology of DKA or calculating infusion rates by plugging values into an equation. When I brought up these concerns with him, he said that I was judging him unfairly because I was more educated when I started nursing. I was quite offended because even though I was aware of the economic factors that led to inflation, that knowledge did not really help me in figuring out how to manage someone in septic shock.

He did, however get me thinking about nursing education in general. I have worked with many students from the school that my student was enrolled at and they all mentioned that their school concentrated far too much on nursing theory and not enough on research and data interpretation skills. Based purely on anecdotal data collected during three night shifts, nurses who had another degree in the sciences were much more comfortable with gathering and interpreting data and understanding the biochemistry behind medications and disease processes. Sometimes I think that perhaps there should be a greater barrier to entry in the profession but I realize that the nursing shortage issue would be exacerbated. So nurses discuss – do you think that new grads are adequately prepared to face the job? What do you wish was taught more in school?

Old is Gold

2011-09-12T23:36:00.001-04:00

I’ve noticed that my department’s staffing demographics are somewhat unusual because we have a lot of young staff. I’m defining ‘young’ as under 35 with 3-6 years of nursing experience. We also have a few ‘well preserved dinosaurs’ (their term, not mine) who work mostly part-time/casual hours. I have nothing but the best things to say about our dinosaurs because they took me under their considerable wings and set me on the right nursing path. However, when it comes to adopting new technology, some of them are downright useless! Every shift worked with them involves listening to how the order entry system is an abomination upon God’s Good Green Earth and could possibly be an additional horseman of the apocalypse that’s not mentioned in the Bible. Many of them are also viciously opposed to the new defib pads because they feel that the glue is inferior to the previously used brand.

So imagine my luck when I got partnered up with one of the dinosaurs in resus and we got a patient having a big ol’ stemi. We did the usual stuff to stabilize him for a transfer to the cath lab. On the way there the man went into v-fib. We tried to shock him but for some reason the shock wasn’t delivered. Absolutely panicking, I start throwing things out of the emergency transport bag looking for a new set of pads when my partner took the paddles attached to the defibrillator and used those to shock the patient. The baby docling accompanying us was speechless as was I because the monitor showed an organized rhythm and bought us just enough time to get the patient to the cath lab.

In summary – lesson learned. Dinosaurs may be old and roar a whole lot, but their bad-assery is NEVER to be underestimated. Ever.

Its been a long time - I shouldn't have left you...

2011-08-09T21:03:00.000-04:00

I can't believe the last time I posted was in May! I've got so many half baked posts on the back burner but I haven't had any time to update. I started doing some agency work to kick start an aggressive project entitled, 'save a down payment or else work shifts with C. diff patients forever'. I was very close to landing a dream condo but got outbidded by a whole lot so it's back to trolling the real estate section of my local papers. In between psychotically obsessing over the real estate market, I've also been traveling which meant limited and/or prohibitively costly wifi access.

In any case, more posts are coming up - I'm here to stay blog world! I'll conclude this brief post by quoting a wise patient of mine who stated his reasons most eloquently for not taking his prescribed meds: 'I can't drink if I take those ma'am'

Let the good times roll!

Words of Wisdom

2011-05-20T22:37:00.000-04:00

Yesterday I was taking care of an otherwise healthy 82 year old man with a nasty FOOSH injury when he said that I looked quite sad. I was actually quite happy except for the fact that I was starving and couldn't stop fantasizing about the ginger beef noodles in my lunch bag the entire time I was getting him prepped for the OR. I guess my hungry face is the same as my sad face which makes sense because when I'm hungry, I'm sad. Since this poor guy had been NPO longer than me, I decided it would be a wise idea to keep my yap shut. Before I had a chance to explain myself, he took my hand in his good hand, looked at me straight in the eye and said with the utmost sincerity, 'sweetheart, the world is large and you're insignificant so do whatever the hell ya want because no one will give two hootin' shits about it tomorrow!' Well said sir, well said!

Call me Nurse Muskels

2011-05-17T01:15:00.000-04:00

In yet another night, my shoulders were aching from the crushing weight of self-loathing for having picked up an extra shift. I was assigned to the resus room but since my partner and I didn’t have any patients, we were helping out in the rest of the department. Just as I was frantically ripping off my sweat soaked gown from an isolation room, another patient looking worried told me that he saw the guy in the room next to him downing a large bottle of pills. “FML” I thought to myself as I walked away from the piping hot cup of green tea with just the right amount of honey in it and walked over to the room. Sure enough, the guy had downed at least three-quarters of a bottle of gravol. I asked him why he took all that gravol, he said that he was nauseated! “F F F FML” I thought once again as I called the doctor and charge nurse to have him moved into a monitored bed (ie: a resus bed because that’s all that was left). I had finished hooking him up to the cardiac monitor and was drawing up some valium for the seizures I knew he’d have (because such is my luck) when he got all twitchy and said that he had to pee. I gave him a urinal but he said that he also had to do a number 2 and climbed mighty fast out of the stretcher. I wasn’t about to fight with a 270 lb, 6”7’ man so I put on my sweetest voice and told him that me and another nurse would walk with him because his balance seemed to be getting worse. I could feel my heart sinking as I said that because I could feel that this wasn’t going to end well. And it didn’t. Just as he crossed the doorway from the resus room to the hall, he had a massive tonic-clonic seizure. I got to be the unlucky nurse close enough to catch him while avoiding being hit by his behemoth spastic arms. The doc came running and was all frantic when she asked me if he hit his head. I said no because I caught him just in time. “Are you kidding me? You CAUGHT him? He didn’t fall on you? Are you hurt?” Now I’m not exactly petit but I don’t look like I can catch a seizing man that size either. Patients came out of their rooms to see what the commotion was all about and my feat of superhuman strength was verified by them. Eventually six of us managed to lift him into a stretcher and start treating him for anticholinergic poisoning.

Moral of the story:
When nauseated, start by taking one PILL of gravol, not one BOTTLE.
Strength training has benefits beyond being a tool to be really really ridiculously good looking!

Really??

2011-04-26T14:02:00.000-04:00

Dude gets dared by his friends to try ketamine for the first time and is brought by them sinking in the k-hole. I ask the friends what he took and they look at me most solemnly and seriously and tell me he must have had a bad cup of coffee several hours prior to his arrival. Really? F%$k you! At least save what little dignity you have and tell me the truth! I kicked them out after that because I was feeling annoyed and chocolate deprived.

Uptown Girl is Admitted to a Downtown World

2011-04-05T19:35:00.000-04:00

There I was having just finished transferring some dude on some overdose to the ICU when the charge nurse tells me that she’s bringing in an exquisitely coiffed 71 year old lady with congestive heart failure. Soon enough I hear the crackles of wet lungs being wheeled towards me and I get ready to do my thang. The lady was quite pleasant, if not a bit snooty and started to change out of her very expensive street clothes into her own silk/cashmere robe by none other than Chanel (yes, I think I did quadruple takes at that). I did my assessment, got an ECG, established IV access, got the blood work done, put her on some oxygen, got a chest x-ray ordered for her and told the doc to come in and see her. The poor doc was getting into the stages of being heavily pregnant and was completely overwhelmed by an anxious family of a man with a shoulder dislocation. She gave me some orders to kick start my patient’s care and off I went to deliver some high quality nursing care. I told the patient that the doctor would be a little while but I got some advanced orders so she could be more comfortable. The lady thanked me as I pushed in some IV lasix. Sure enough she had to pee. I didn’t put in a catheter because she was completely ambulatory, the bathroom was beside her bed and she adamantly refused it. But she didn’t like the look of the newly cleaned bathroom so she asked for it to be cleaned again for her own reassurance while she insisted on staying in agony with a full bladder. I kept telling her that the bathroom has been thoroughly cleaned before she came in and if she has to pee that badly she should go for it! Watching her squirm made me want to pee even though I was thoroughly dehydrated. She kept refusing. Fine, whatevs. She kept squirming while the cleaner poured no name brand Lysol into the bucket. Then all of a sudden, she wailed. Then sobbed. Finally, she yelled at me to come to her bed. I dutifully unglued my tired arse from the comfy chair and went to answer her distressed cries which was when she took out $700 from her wallet and shoved it at me to go to her apartment, get her a new gown, underwear and toiletries!! A week later, I’m continuing to kick myself for not having ditched the smelly, snoring drunk in the room next door and grabbing a cab to get her stuff because I still need the money but don’t want to pick up another shift!

Too Much Charting?

2011-03-17T23:50:00.004-04:00

A couple of weeks ago the department was absolutely swamped and really short staffed due to a particularly heinous strain of cold and gastro making its rounds with the staff. The staffing situation was dire enough that the manager changed her shirt into a scrub top and started helping out. It was quite a funny sight to see a woman in a pencil skirt, flats and a scrub top walking around the department carrying urinals full of hematuria. But I digress – that’s not the point. She eventually triaged a patient to fast track for back pain. Long story short, the woman was a drug seeker who’s very familiar to most of the staff. She didn’t let me examine her nor did she let the doctor do the same. Eventually, the doc told her to eff off (not quite like that, but her intention could not be mistaken) and that she could either get toradol or nothing before leaving. She then pretended to have a syncopal episode (seriously, how many times does a syncopal episode result in someone falling neatly onto the egg-crated mattress?). When she realized that the nurse was clearly ignoring her, she sat up and started to threaten her and swear at her using profanities that would offend a seasoned sailor’s sensibilities. Rightly so, my colleague didn’t put up with it for too long before she called security and had her ass dumped back out into the cold. Like any good nurse, she then documented. Then documented some more. She also included some direct quotes from her in her documentation because the patient was just that vile.

Lo and behold, this issue was brought up during our education day by the nurse clinician and our manager. Their position was that including some of her direct quotes was unprofessional and that now this charting would follow the patient around in her future encounters with the healthcare system.

I do see my manager’s point of view. Once something is written, there’s no taking it back. If she ever cleans up and has to access an ER again, this documentation is going to unfavourably affect how another nurse treats her. I can also see how in the midst of illness, one says things that they later regret and a person’s actions in one moment of time are not necessarily reflective of who they are. However, had I been in my colleague’s place, I probably would have documented in a similar style. Why? I’ve also dealt with this patient many times before and each encounter ends in almost the exact same way. A friend of mine who works in an ER across town also gets sworn at by her every time he invokes the fury of the triage gods. And yet, the only thing I’ve seen documented is that “patient is verbally abusive to staff”. I don’t think that this statement covers exactly how vile she is towards the staff. We regularly use quotes to capture what patients tell us so I don’t see why we can’t use direct quotes to document verbal abuse thrown our way. Moreover, in the unlikely scenario if she ever decided to sue my colleague, she would have documentation about the patient’s thoroughly reprehensible behaviour to back up her actions.

Obviously, I’m still not decided on where exactly I stand on the issue but I feel that I better pick a position soon because she’s not going to the only aggressive and abusive patient I’ll deal with.

My Triumphant Return

2011-03-09T23:28:00.003-05:00

So I come back to Canada a little later than anticipated and all everyone is talking about is how Timmy Ho’s not only serves subpar (yet strangely addictive) coffee but is now also involved in emerg patient care. I figured that since I’m still in my post-vacation haze, I’ll contemplate those issues after I unpack, reacquaint myself with my soft bed, unpack, eat smuggled chocolates and upload my pictures. And get a couple of shifts done and over with.

But things rarely work out the way I want them to. I walk into a department that’s on the fast track to hell in a hand basket. Waiting room was packed leaving only standing room. An insane amount of eyes were trying to bore into the triage nurses’ skulls, probably hoping that if the gatekeepers to the department spontaneously combust, they would be quickly seen by the shining knight in a stethoscope and save their day. Inside the department, there were two codes (at the same futtha-muggin time!!!!) going on, one of which was a paediatric code and there were old, obtunded, septic patients circling the drain in every corner. It's as if every single nursing home had an outbreak of the plague and sent thier residents to our lovely department.

Not even fast track was showing any signs of patient movement. Everyone had a broken something with neurovascular symptoms and the simple lacs were gushing blood – almost as if arteries were involved. Which they were. Of course, the cherry on the crap sundae that was fast track were the FOUR patients that had bed bugs. FOUR of them. Getting them isolated and bathed made my skin crawl a thousand different ways. I’m still itching at the thought of it. Fast track spilled onto the outpatient surgery unit after a while, which isn’t too far away from one of my favourite Starbucks.

At least I still had my super-power of blood drawing. Got 4 vials from a knuckle vein! It's good to be back.

I'll be Back in 2 Weeks...

2011-02-09T21:00:00.001-05:00

Because I'm on vaykay :)

Sleep Assessment

2011-02-05T22:02:00.002-05:00

The past couple of shifts have been INSANE! Multiple codes every day, transfers to other facilities every other hour, police crawling all over the department all the time and everyone wearing the look of incomprehensible exhaustion. My ER saw a record number of patients this week. To say that it was absolute chaos and insanity would be the understatement of the year. When I finally got home after my last scheduled shift, I could barely walk in a straight line let alone speak coherently. I don’t know how I managed to change out of my clothes and wash up before heading to bed but it happened (I had witnesses).

Just as I settled into a really deep sleep, my sister woke me up in a panic and said that she just got a very sharp and sudden pain in her stomach and she feels like throwing up. Sister hasn’t been sick, hasn’t had any changes in her diet and wasn’t injured. She also never ever EVER gets abdominal pains, nor does she take any meds. I asked her some detailed questions and of course asked about her last normal doody (yes even family members aren’t safe from doody questions if they bring up abdo issues) and if she had any urinary symptoms. She said no to everything. Since I was too lazy to get out of bed, I asked her to gently palpate around her abdomen and tell me if any part hurts or is relieved by palpating. She told me that everything was normal. Not being able to think of anything else, I told her to take a gravol, go back to bed and if the pain worsens, wake me up. Naturally, she fell asleep.

The next morning, she told me that her stomach was still hurting and asked if she should go to our family doctor. I was at a complete loss. “When has your stomach been hurting since?”

“Since last night loser!”

Baffled by her annoyance, I shot back, “Well how the eff was I supposed to know that?”

“Dude wtf is wrong with you? We had this conversation at 3 this morning. You told me that if my stomach was still hurting, I should go to the doctor”.

At this point, I was completely baffled. “Alright imma hold you up a minute. What exactly did we talk about and what did I say?”

Now it was sister’s turn to be lost. “You don’t remember?” She then repeated everything I had told her up to and including the part about me telling her that if I didn’t sleep at that moment, my eyes would bleed out of my head.

I honestly don’t remember a single word of that conversation. In fact, the only thing I remember is getting into bed at around 0130 and waking up refreshed at 1230. As far as I’m concerned, I slept for eleven straight hours. This is troubling because up until now, I have never had a conversation that I haven’t remembered. My sleep assessment is the first incidence of amnesia I’ve experienced (or at least, the first incidence that I've been made aware of). However, once I managed to snap out of the ‘holy exhaustion related memory loss batman’ frame of mind, I was quite impressed that even while I was half asleep, I was able to go through an abdominal assessment. Maybe I should sleep through assessments more often at work (kidding – sort of).

Btw, the sister is not 100% fine but we did have a yummy lunch together. She is no acute distress at present :)

The Customers

2011-01-29T04:40:00.000-05:00

It’s nice to have friends who are also nurses. A few days ago, one of my very good friends (I’m looking at you, J) met up with me after a harrowing night shift to vent (errr debrief) about a challenging family member who demanded medical care only to refuse every single treatment option offered. I’ve run into far too many similar situations and they’re a pain in the ass to deal with Every. Single. Time. I greatly respect the fact that a patient knows their body better than anyone else and that those who live with chronic diseases often know more about effective treatments than emergency RNs and MDs. I for one welcome the feedback because it not only enhanced my own learning but allows me to provide better care. However, when patients come in armed with a medical degree granted by Drs Wiki and Google and expect us to follow random internet advice to cure what ails them because they are ‘customers’ of the health care system, it’s not going to happen. Ever. Why? Because we use best practice guidelines to provide COMPETENT and SAFE care even if that care contradicts the generous stacks of printouts from magicunicornhealingpower.com. There are LEGAL ramifications to not providing care that is based on sound science.

One of my most irritating encounters happened with a middle aged man who came in complaining of shortness of breath. It was clear he had pneumonia (what with the raging fever, gunky sounding lungs and the dramatic expectoration of army fatigue coloured phlegm) but he absolutely refused the antibiotics citing concerns about antibiotic resistance and his consumer power. And yes, he had stacks of printouts, mostly with ads for weight loss remedies on the side, to ‘argue’ his case. Logic did not have a place in that exam room. I hate to get all flustered, but WTF??! Why bother coming into emerg at all?

This whole business about the customer always being right is total crap when it comes to providing safe, competent, evidence based care to a ‘customer’ who picked up their medical knowledge from internet pop-up ads and snippets of TV shows.

DISlike

2011-01-23T02:07:00.001-05:00

It’s 0200, I can’t fall asleep (again) because of insane switch overs between days and nights so I decide to boot up my computer and watch some mindless movie to pass yet another insomniac night. While I’m randomly surfing, I check my facebook (of course) and this doctor with whom I had a major kerfluffle with regarding scope of practice and respect in general sent me a friend request! Not gonna happen. In fact, the privacy settings got bumped up even higher. Now I’m just too creeped out to sleep.

We (Still) Have No Cure for the Flu

2011-01-14T15:45:00.000-05:00

The flu season is upon us and that means snotty noses, fevers, body aches, chills and generally feeling like crap for a while. You want to feel better quickly and that’s understandable. After all, having the flu sucks. But if you’re an otherwise healthy individual (ie: not old, no pre-existing respiratory diseases, etc), please don’t go to an emergency department demanding that the nurses and doctors give you Tamiflu. You’re depriving yourself of the comfort of your own home and bed and are spreading your germs around to people who are a lot sicker than you. There’s nothing we will do that you can’t do for yourself, like resting, taking Tylenol/advil for symptomatic relief and drinking a cup of hot tea. Also, if you’re a 20-something year old man-child, please don’t send your mother to the nursing station every 20 minutes to ask when the doctor will see you and if he can get something hot to drink. I’ve given your child Tylenol (which the doctor would have told you take anyways) and there’s a Starbucks in the lobby 10 feet away from you. They have all sorts of hot beverages for your precious baby. Following these tips won’t make the flu go away any faster but it will save you a huge wait time next to the drunk who keeps pissing himself that you could have spent sleeping at home.

Is it possible to eat so much that your stomach starts to displace your internal organs?

2011-01-01T17:08:00.000-05:00

Normally, I consider myself a discerning glutton but this holiday season has been filled with eating on a scale unheard of until about 10 days ago (right when I wanted to pick up working out on a consistent basis again). Normally I don’t eat during night shifts but when I worked straight nights during Christmas, I was powerless to resist the goodies of our annual Christmas potluck. I was deliriously happy when I realized that the majority of my coworkers were amazing cooks on the side! Then I was stuffed silly by my elderly relatives as soon as I got home from work. Tonight is not going to be any different. In fact, as I write this post, I have 3 beef dishes on the stove and some baklava in the oven for a dinner party tonight. The point of this post? I’m far too stuffed to write anything relevant to nursing so I’ll just raise a glass to great food shared with great company, holiday shifts that were uneventful and let me have a chance to actually get to talk to my coworkers and wish you all a very happy and healthy new year!

In need of some Jamz

2010-12-19T21:22:00.000-05:00

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

2010-12-17T15:15:00.001-05:00

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

2010-11-29T22:43:00.002-05:00

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!

2010-11-04T22:45:00.001-04:00

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*

2010-10-30T02:45:00.003-04:00

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

2010-10-25T16:17:00.001-04:00

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

2010-10-18T19:20:00.000-04:00

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?

2010-10-15T00:00:00.004-04:00

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

2010-10-08T00:52:00.000-04:00

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

2010-09-30T02:28:00.000-04:00

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

2010-09-27T02:56:00.001-04:00

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)

2010-09-20T12:56:00.003-04:00

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

2010-09-18T01:52:00.002-04:00

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

2010-08-17T00:22:00.000-04:00

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

2010-07-29T16:21:00.001-04:00

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!

2010-07-18T02:40:00.001-04:00

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

2010-07-13T15:31:00.000-04:00

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...

2010-07-03T00:53:00.000-04:00

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

2010-06-26T01:04:00.002-04:00

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

2010-06-21T15:58:00.000-04:00

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!

2010-06-17T14:09:00.000-04:00

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

2010-06-06T17:03:00.000-04:00

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

2010-05-25T23:15:00.000-04:00

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

2010-05-21T12:26:00.000-04:00

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!

2010-05-14T02:08:00.001-04:00

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

2010-05-09T19:55:00.001-04:00

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

2010-05-07T12:06:00.002-04:00

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...

2010-05-01T00:41:00.000-04:00

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

2010-04-23T23:42:00.000-04:00

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

2010-04-19T21:00:00.002-04:00

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

2010-04-18T01:55:00.001-04:00

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

2010-04-09T21:36:00.001-04:00

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

2010-03-28T02:54:00.002-04:00

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.

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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”.

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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.

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

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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

2010-03-24T02:07:00.004-04:00

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?

2010-03-19T02:31:00.003-04:00

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

2010-03-12T20:09:00.002-05:00

Self explanatory, really.

Spousal Abuse

2010-03-05T21:04:00.002-05:00

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

2010-03-01T13:02:00.002-05:00

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

2010-02-22T21:08:00.001-05:00

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

2010-02-17T21:03:00.006-05:00

Tools of the Trade

Fuel

Winter Sunset

It’s Raining Forms

2010-02-17T20:58:00.001-05:00

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

2010-02-12T03:16:00.001-05:00

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

2010-02-06T03:16:00.001-05:00

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

2010-02-01T01:07:00.001-05:00

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...

2010-01-24T00:38:00.001-05:00

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

2010-01-18T23:17:00.001-05:00

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

2010-01-15T01:12:00.001-05:00

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

2010-01-11T02:11:00.003-05:00

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

2010-01-09T04:00:00.002-05:00

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

2010-01-03T03:16:00.002-05:00

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.

Healing the Walking Wounded on Boxing Day

2009-12-30T14:49:00.002-05:00

In order to get New Year’s off, I had to compromise and agree to work the week of Christmas. I was preparing for the worst on Christmas eve and day. Instead I was pleasantly surprised. Working on Christmas was actually quite lovely. The department was calm, the staff was happy and the patients who did come were incredibly thankful and nice. However, the next day, Boxing Day – well that was a different story. Boxing Day can be thought of as the American equivalent of Black Friday – a perfect storm of drastically reduced prices and injuries. Weather permitting (or not), shoppers line up as early as 0100 to score a great bargain, and I suspect to get a little bit of a break from the family togetherness of Christmas.

I was assigned to work in fast track and well, that was a complete bloodbath. Battle weary men and women limped in one by one, and then ten by ten with their swollen and sprained ankles while clutching their loot for dear life. A potentially major kerfluffle broke out when three patients confused their shopping bags and started to walk away with each others’ merchandise. A little old lady called a younger woman a shameless floozy after having discovered that the younger woman had managed to buy the last 52” Sony Bravia television available. Even some of the staff took extended breaks to scour the malls for some deals. Most came back shell shocked – one came back after having spent $3500 on some serious electronics and clothes. Minor lacerations were the theme of the evening when people started to dig into their merchandise with a great deal of fan fare and sharp objects. After tensor wrapping sprained ankles, setting up countless suture trays and administering an endless amount of tetanus vaccinations, I did my part for the economy and scoured the aisles for offers I could not refuse. But not before having taken a substantial shower and a long sleep.

Happy holidays and a very happy new year to everyone :)

More Evidence That Rap Music Promotes Violence

2009-12-23T01:15:00.001-05:00

Emerging Dazed and Confused from the Land of Night Shifters

2009-12-22T01:35:00.001-05:00

“Dude! I thought you were like dead or married or something! Where have you been?”

Thus I was greeted by one of my more colourful friends when I ventured out in the afternoon for lunch after working 7 nights in 9 days. How do I feel after this (mostly) self inflicted torture? Let’s just say, off. Usually I like to work nights but this time it has been particularly vile because I have been denied my nap during breaks. Due to ongoing construction, the ER nursing lounge is inaccessible, which means that the lousy nap chairs from yester-year are also inaccessible. Without a nap I’m a terrible nurse. I can’t get IVs in, I can’t collect blood samples, the thought of having to catheterize a little old broken hip lady induces terrible sobs of anguish and people asking me ‘how much longer until I see the doctor?’ makes me seethe with uncontrollable, mouth foaming, profanity hurling, stretcher kicking rage. In a moment of shocking desperation, I think I actually fell asleep while trying to get a history from a psych patient. Perhaps Santa will reward us lowly nurses with a decent lounge and some spare stretchers or couches? Unbloody likely.

In any case, I learned that after waking up entirely disoriented and slightly scared at having seen sunlight for the first time in a week, it is best not to acclimatize to the day time world by trolling in a mall full of herds of bewilderbeasts frantically looking for presents. At least lunch was delicious and fun!

Life Lessons Learned and the the Abundance of Pooh

2009-12-16T05:01:00.001-05:00

In yet another teaching shift, I got assigned to a new grad nurse who was quick on her feet and even quicker in her thinking. She told me that she was really looking forward to learning about the indications for using different kinds of antibiotics. However, she got a lesson in pooh (really, aren’t all lessons about pooh?). She learned that it is far better to collect blood and urine samples before giving a massive tap water enema to a little old bunged up lady who is just confused enough to crap all over the room and then stand in the middle of the carnage with a smile on her face. Some lessons can only be learned through experience no matter how far in advance a warning is given.

One of Those Days

2009-12-12T03:03:00.000-05:00

17 year old female, c/c – “got my cherry popped at my doctor’s office with a q-tip and some metal. Can you fix it?
Have a seat.

37 year old man, c/c – “Some ho did something to my junk she didn’t get paid to do”
Have a seat.

17 year old male, c/c – “I’m really high, I got the munchies and I heard the nurses here are really hot”
Have a seat.

26 year old female, c/c – “I think I was pregnant a year ago. Can you tell me if I actually was?”
Have a seat.

34 year old male, c/c – “My fern tried to strangle me when I slept and now I’m going to kill my brother all of you and the fucking fern”
Security.

44 year old male from home via EMS – Allergies x1 year.
The current wait time is 9 hours – give or take. Have a seat.

Unkempt male of undetermined age – “Where my Percocet bitches!!?!”
Security.

29 year old male, c/c – “I haven’t had a shit in 3 days and I want…”
Patient was interrupted by his own very loud and putrid flatulence.
“Never mind, I feel better now”.
What the hell??

19 year old male – “Do you guys prescribe medical marijuana?”
“No”
“Uh… well… I have cancer”.
“You should be ashamed of yourself”.

I helped to save many lives, and left a lasting impression on many more.

Dos and Don’ts of a Staff Party

2009-12-06T20:17:00.005-05:00

It’s that time of the year when the crisp winter air is filled with festive joy, store windows are decorated with Christmas scenes, there’s an extra sparkle in children’s eyes and all steadily employed people are filled with varying degrees of dread, apathy, anxiety and yes, even excitement about the annual Christmas party. Socializing with one’s coworkers while not scrub clad can be somewhat daunting because when removed from the hospital setting, there aren’t any psychotic, belligerent, needy, disrespectful, bitchy, douchbagy, moronic and/or idiotic patients/staff to deal with. As such, engaging in small-talk can be awkward, if not outright impossible. Parties are also a social minefield because as unbelievable as it sounds, a vast majority of the staff have lives outside of work. Sometimes, those lives include dating each other, breaking up, working together uncomfortably for a while before a new normal is established.*Lastly, staff parties are an extremely weird combination of coworkers, bosses, alcohol, food and 80s dance music which can make effective and fun socializing all that much more difficult.

Since staff parties are a better dressed, tressed and fed extension of work, it’s important to remember to maintain a certain amount of decorum and reserve. With this in mind, here is my list of dos and don’ts of a staff party loosely based on this year’s party mishaps.

Do try to be civil to each other no matter how much you wish your foe was under a bus.

Don’t tell your foe that you were ardently hoping for them to be under a bus.

Do enjoy the catered food and open bar.

Don’t enjoy the open bar to the point of which you start to loudly vomit in the ladies room and end up being dragged home by another staff member while your boyfriend stays behind to pay the manager off for the damages incurred.

Do compliment your ex on his/her educational/professional achievements.

Don’t berate them for their weight changes, poor sartorial decisions and even poorer choices in mates.

Do make an effort to introduce your partner/date/family member to the rest of the staff so they don’t feel left out.

Don’t let your companion be in a foul mood at one of your past transgressions, especially if their revenge plot is to out how you want to take over someone else’ job and forever taint you as a treacherous corporate climbing snake.

Do show of your fancy footwork when kickass 80s anthems are blasted, especially if you’re the chief of medical staff.

Don’t dirty dance with the nursing manager and end up with your tie lost and your shirt buttons undone, especially if you’re the chief of medical staff.

This is by no means a comprehensive list but merely guidelines that one should try to follow in order to have a successful staff party experience! Please share your dos and don’ts and keep the hilarity going!

*HR neither condones nor endorses this behaviour.

Tweedle Dee, Tweedle Dumb and Tweedle Dumbass

2009-11-30T14:27:00.001-05:00

It’s befitting that I got to take care of the following three gentlemen after getting TNCC* certified. Three home-boyz found themselves in a slight altercation involving a ‘fine ass bitch’ who turned them all down. Home-boy #1 took out his gun and shot home-boy #2 near the tibia. Home-boy #2 was not impressed so he shot home-boy #1 in the upper thigh. Feeling a little left out and getting pissed off at home-boy #2 for shooting home-boy #1, home-boy #3 took out his gun but wasn’t quite schooled in how to use it properly and so, ended up shooting himself in the foot. All three of them limped in cursing and bloody and accusing each other of ‘startin’ shit and messin’ wid da fine bitch’ who supposedly belonged to one of them only. At home-boy #1’s insistence, I caved in and called the woman who they were fighting over only to have her curtly tell me to euthanize them all. Needless to say, the ‘po-po’ were also involved.

*TNCC - Trauma Nursing Core Course

Miss Maha if You're Nasty

2009-11-25T00:23:00.002-05:00

A little old lady with a hip fracture after being catheterized: What does RN stand for?

Me: Registered nurse, ma'am.

LOL: Should be real nasty for what you just did to me.

Items Misplaced

2009-11-19T15:37:00.004-05:00

Looking for a clean scrub top before a night shift and this is what I find instead. Had to wear a t-shirt that night :)

Lights

2009-11-15T01:28:00.002-05:00

On my way to work, I pass by an old Tudor style house. Its backyard can be seen from the train tracks and each evening regardless of the weather, there were festive lights casting a lovely glow to the entire house. Every time I had a night shift during the summer, I would pass by that house and I would see a giant barbecue, a myriad of guests, all sorts of flowers in stunning colours and of course all those lights. Being somewhat of a recluse, I always wondered who would have the energy to entertain so many guests so frequently. In winter, the backyard lights cast a beautiful amber glow on the snow and it made me want to befriend that person over a great cup of hot chocolate. There was something about that house that instantly made me feel happier. I know I have dreamed about that house many times.

Last week, was a little different. I was on the train daydreaming and staring out the window but the lights weren’t on. In fact, had I not known about the house previously, I would have never thought to look for it. Thinking that electricity bills finally got the better of the owner, I let my thoughts wander aimlessly once more until I reached my stop. By then, I had forgotten all about the house and started to worry more about my imminent future – namely what kind of department would I be walking into.

As usual, I purchased my latte and walked over to my assigned area to get asked, “Ready for report?”

“Sure”, I replied.

“For now, you only have one patient. She’s a 66 year old woman presenting with diffuse CP, SOBOE x2 days and mild 1+ pitting edema in the ankles with no relief from nitro. Positive trops, no significant ECG changes from previous visits, she’s a bit more comfortable with morphine. Cardiology is consulting on her now so you get to wait for their orders. She really doesn’t want to stay here because she’s convinced she won’t make it out of here so you get to deal with that. Family will be here in a little while. Any questions?”

“No, I’m fine. I’ll get the rest from the chart. Good night”.

“Night”.

I hung around the nursing station for a while savoring my latte while I looked over her labs. Eventually the patient was admitted and I finally got a chance to talk to her. From the minute I walked into her room, I felt as if I had known her all my life. She reminded me of so many people in family that I haven’t spoken to in months just because life gets in the way. Listening to her speak was effortless. I was simply spell bound by her eloquence, charm and her ability to describe the texture of a life that I could not possibly know. I lost track of time as she told me about how she managed to escape Afghanistan in the early 80s, made her way to Pakistan and eventually into California before coming to Canada and resuming her career as a teacher. She paid a heavy price for leaving – she lost three of her four children, her parents and many of her friends. Once she managed to buy a house and provide for her daughter, she started to feel as if she spent her days struggling against the relentless waves of guilt at having survived while having to watch too many of her loved ones fail and pay with their lives. She thought about killing herself – overdosing, throwing herself on the train tracks, jumping from a building – anything that would get the job done but ultimately she could not sacrifice her daughter’s well being to appease her own dark desire for escape. She sought help for her depression and eventually started to befriend others in her community and reestablish roots in Canada. Her daughter grew up, fell in love, married the man of her dreams and had two children who were lavished with love by everyone in the family. She said that for as long as she could, she always wanted her family and friends near her because at any moment, all of the newfound beauty in her world could be snatched away. She did not want to stay in the hospital and have her troponins and ‘lytes measured on a tele floor because she had a house whose backyard needed a new string of lights so she could once more take in the sights and sounds of her loved ones enjoying a delicious meal under their glow.

And that’s when it dawned on me that she owned the house that captured my imagination for so long. I wanted so badly to tell her what seeing her house everyday meant to me – how just for an instant, I was able to let go of my worries completely and just admire the beauty and warmth of her house and its spirit. But as it happens, I was slammed with two new patients back to back who needed a whole lot of work done. When they were discharged, the influx of patients did not stop and she eventually got transferred to the tele floor by another nurse.

I got to work early the next night so that I could visit her, say goodbye and wish her well in her recovery. She coded that afternoon. I doubt I will ever see the same house on my way to work again.

A Family Business

2009-11-07T15:23:00.001-05:00

When asking a patient what he does for a living:

Patient: I’m a dealer yo. My mom’s a dealer. My dad’s a dealer. My sister’s a dealer. My brother’s a dealer. Yo guy, even my motherfucking dog is a dealer.
Me: Foshizzle bro.

*fist bump*

Un-effin-believable

2009-11-03T21:11:00.002-05:00

EMS brought a patient over to triage who called and demanded that he be taken to the hospital to get her H1N1 shot. She was livid that we did not have it. Furious does not even begin to describe how I felt towards her. Similarly, I don't have a sufficient vocabulary to express the amount of loathing I felt towards her for tying up an ambulance for an hour.

Keeping Kosher

2009-11-02T00:07:00.003-05:00

Elderly Jewish patient with a sense of humor who tested positive for H1N1: Is it Kosher for me to suffer from the swine flu?

Me: Sir, almost seven years of schooling and the meager experience that I have as a nurse in this department has not prepared me to answer your question in a satisfactory manner. Would you like some orange juice?

More Photography Fun!

2009-11-01T19:43:00.008-05:00

I was threatened - err kindly asked - by my sis' bf to post some of his work. I'm impressed by the detail!

Adventures in Fall Photography

2009-10-31T19:50:00.011-04:00

These lovely pictures were taken by my awesomely talented sister (ie: little bear) in various places on my way to work. She was using her bf's camera (who is also uber talented but I don't have his work so it can't be posted - yet). I love fall!

Had Edgar Allan Poe Been an Emerg Nurse…

2009-10-25T01:00:00.001-04:00

The Drunkard

Once upon a midnight dreary, while my back ached, weak and weary,
Over many a quaint and curious patient at the triage door.
While I nodded, nearly napping, suddenly there came a tapping,
As of someone rudely rapping, rapping at my triage door.
"'Tis no drunkard," I muttered, "tapping at my triage door--
A well man and nothing more."

Ah, distinctly I remember the bloody night before November,
And each and every staff member had brought a patient to the floor.
Eagerly I wished the morrow, vainly I had sought to borrow,
From my books of assessments thorough –to avoid the cookies from days of yore
And drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s struggling
Thrilled me – filled me with supreme annoyance, never felt before.
So that now to still the beating of my heart, I stood repeating
“Tis no drunkard entreating entrance at my triage door –
Some late UTI-er entreating entrance at my triage door;
This is it, give toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,
“What,” barked I, “please don’t have a complaint I’ll deplore,
But the fact is I was napping and so intently you were tapping,
And so rudely you came slurring, ranting at my triage door”.
And without regard or thinking, he barfed upon my triage door,
Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,
A man now pickled, whose foot-falls dragged in the department’s floor.
“Wretch,” I cried, “why did God bring thee – by the devil he hath sent thee
Respite – respite and valium please for thy abnormal CIWA score
Why, oh why this loud decree of your drunken presence on my door?!”
Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,
Whether taxi sent, or whether ill-fate tossed thee here ashore,
Desolate, yet all undaunted, in this department un-enchanted,
In this hallway by Horror haunted--tell me truly, I implore--
Is there--is there calm from gravol?--tell me--tell me, I implore!"
Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!
By the score of twenty and eleven – by the valium we both adore –
Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?
Please, oh please, I beg thee, use the bucket on the floor.”
Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting.
"Get thee out of the department and save my night from being abhorred!
Leave no chunks of vomit as a token for my tolerance thou hast broken!
Leave here with this train token! – Quit the bed and leave the main floor!
Take thy stench as you depart, and take thy form from out the door!”
The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoring
On the pallid stretcher mere inches from the door;
And his socks have all the seeming of a mould that is steaming
And the lamp-light o’er him streaming throws his shadow on the floor;
And my break retreating into shadows that was planned for four,
Shall be taken – nevermore!

Have a spooooky halloween!

Rethinking Professions

2009-10-23T01:43:00.004-04:00

Recently, I was working fast track and I brought in a patient who needed a script for ramipril and atenolol because she forgot her meds in another province. Being surprised that a) the script refill wasn’t for narcotics or benzos and b) she was prepared to wait for a while with a copy of the Massey Lectures, I tried to get her seen quickly but since we were expecting EMS to bring a patient with a CTAS of 1*, I just ended up chatting with her for a while. We started to talk about job security and how nursing seems like a very safe profession since there are always sick people who need attention (tell that to the half baked suits that think firing nurses is the best step towards achieving fiscal goals). I told her that I was considering applying for a part time/casual position at one of the local clinics so I can get rid of my student loans a bit faster. She disagreed with my choice and told me that I ought to consider becoming an escort! After recovering from nearly obstructing my airway with my latte, I had to tell her that as much as I would like to cease worrying about money, I can honestly say that nowhere in my psyche have I ever considered escorting (is that the proper verb?) as a potential means to achieving that end. Apparently I have the ‘right personality and look’ – I suppose telling Mr. Drunky McDrunkington that he’s wearing a hospital gown because he pissed his pants numerous times while wearing my ‘I’m too bloated and tired to care wtf I look like scrubs’ is the escorting look du jour. Since I’m in a rather forgiving and jovial mood (I got New Year’s off!), I’ll just pretend that she was trying to complement me in her own bizarre way but when all is said and done, I’m rather offended and the entire discussion just left me with a sour feeling in the pit of my stomach.

*CTAS (Canadian Triage and Acuity Scale) 1 is an honest to goodness emergency - if you're ever in an ER and hear people scrambling about saying CTAS 1, it means that a patient who's about to start knock knock knockin' on heaven's door is going to be coming in shortly and you will have to wait until said pateint is either stabilized or is transferred to the Eternal Care Unit.

Letting it All Out – While Retaining Everything

2009-10-18T01:59:00.001-04:00

Old MD Girl’s post about how one should maintain their composure and appear zen-like while interacting with patients at all times is inspiring this particular rant. I got a memo stating that admin is starting mandatory once a month round table discussions aimed at airing out the nursing staff’s frustrations or concerns. There’s some crap written about how those discussions can have the potential to positively benefit the entire staff because concerns can be dealt with as they come along. There’s also some other crap about how reflecting on our practice with staff at varying skill levels can improve our overall practice. My personal (ill-articulated) thought - suck it! I do not want to give up my precious break to sit awkwardly in front of some suits to talk about how much I hate the smell of C. diff in the morning. Nor do I want to talk about how irrationally angry I get when my latte doesn’t have the right proportion of espresso and milk because I’m nagging the barista to hurry up so I can make it to a meeting to talk about my ‘feelings’. I can understand the need for debriefing sessions after a particularly memorable or horrendous event but being forced to go every month to these ‘vent out your feelings sessions’ when I do just fine venting over great food with my friends is simply cruel. Not only that, the entire concept seems redundant to me because up until now, I thought monthly staff meetings and providing proof of competent practice to the provincial licensing body were for the very same purpose. No matter how stressed I am, I can guaran-damn-tee that I would find peace and quiet much more relaxing than having to restrain myself with politically correct language in front of power suited chumps.

Tasteful Fixtures

2009-10-15T14:02:00.003-04:00

I want this in my bathroom for Halloween! Also tempted to put it up discreetly in the ER’s shower room and await the inevitable meeting with admin about the utter lack of professionalism that would follow!

Found via Gizmodo

Status Dramaticus

2009-10-13T22:15:00.000-04:00

From my highly un-researched, completely anecdotal experience, ER nurses are generally thought of as ‘tough as nails’, ‘bitches’, ‘know-it-alls’ but rarely are we acknowledged as overly emotional cry babies who can’t keep their shit together. However, I have the great fortune (note sarcasm) of working alongside such a nurse. Every call bell, every new patient brought to her when it’s ‘busy’ and every patient/doctor/nurse/lab tech/porter who’s being a jerk to her brings her close to tears and for some reason, I up having to clean up the resultant mess because she’s too busy wailing (complete with snot and tears) in the bathroom. When I’m off work, I love shooting the proverbial shit with her, but when we are working together, I feel myself cringe because I know I will be running off my feet no matter how organized I keep my area. Not being a completely insensitive dunce, I tried to ask her if anything has been bothering her lately but her excuse for her outbursts is that she is just a very emotionally expressive person and that she feels that it’s better to let everything out rather than keeping frustration bottled up. Fair enough. Except when she’s busy sobbing, someone else has to pick up the slack that she creates. Lately that lucky person has been me and I’m getting just a little annoyed. I get it – nursing can be tough. There are always setbacks and jerks that must be dealt with but there has to be a point in which one has to put on their game face and start paddling through shit creek. Breaking down into a blubbering sobbing mess at every hiccup doesn’t help in anything except erode others’ confidence in a nurse’s ability to function well under pressure – and it’s not very professional either.

Whiny Cry Babies or Warning – Rant Ahead

2009-10-07T01:52:00.000-04:00

I don’t know what’s in the local water supply but lately I’ve been inundated with patients who are a) obstructed in the small bowel and b) prone to throwing screaming fits of agony when I have to put in an IV and get blood work done. I would imagine that having your doody machine tied up in knots or bunged up to the point of needing surgical intervention would hurt a hell of a lot more than a puny needle collecting minuscule amounts of blood. All friggin’ day I get to hear bitching and screaming about how 25 gauge needles are instruments of superb and exquisite torture. And that was before GI and Gen Surg wanted 18F NG tubes shoved into tiny nares. Also, why, WHY would someone eat a giant pork souvlaki meal after having a confirmed obstruction and being told in no uncertain terms that eating is strictly off limits? Guess who gets to provide barf buckets to those degenerates? Honestly, some days, people really suck! Rant over. Now to head off to bed and dream of something better than small bowel obstructions.

File this Under WTF??

2009-09-30T19:26:00.001-04:00

Towards the end of my shift, I got a patient triaged under medical device problem. Turns out his PICC line was blocked. No biggie – I got the doc to order some heparin so I could get his treatment started as soon as possible. I got into his room and was greeted by a bunch of ex-football player, frat boy, keggers every night kind of guys. The patient had a PICC line because he developed a post-op infection in his shoulder and needed q6h antibiotics for a while. I asked him when the line became blocked and that’s when things started to make a lot less sense. Apparently a blocked PICC line wasn’t his only problem. Turns out his buddies decided to see what would happen if they shot a few tablespoons of beer and finely ground nachos into his PICC line to see if he would get drunk faster! As I tried to ungracefully pick my jaw up off the floor, they started to high five each other. The dressing was filthy and smelled like rancid beer. I changed the dressing with 4 guys telling me to “shoot some crack in his line miss”. Had I not been exhausted I would have stuck around a bit longer to see what the doc and interventional radiology would do but I figured this moron wasn’t worth the trouble. However, here’s the real kicker – the patient is a masters student in immunology! Stupid cuts across all socio-economic boundaries.

Revenge is a Dish Best Served in 57 Minutes

2009-09-28T15:58:00.002-04:00

I am firmly convinced that HR departments (at least the one in my hospital) are run by sadistic, soulless evil minions of Satan. After doing four full night shifts in a row, I went to the department to pick up some income tax forms. Now herein lies the dilemma – my shift usually ends at 0700. The HR department opens at 0800. I went down to the department at 0740 to see if some kind soul would just type in a seven letter password, click print and hand me the piece of paper so I could go home, flop onto my couch and dream that I’m a fabulously wealthy traveler. Instead I walked into a room full of people who at first completely ignored me and then proceeded to berate me for being there. I very politely asked if they could kindly print me the form so I could make my train and get some rest before I would have to come back for yet another night. One particular man told me that I would have to come back in precisely 19 minutes to get the form. For a moment I thought he was joking. He was not. I asked him again, this time practically begging. He told me that since the department is not officially open for another 19 minutes, he cannot print me the form I needed, despite the fact that he was logged onto his computer. Clearly, I was going to lose the battle so I retreated to Starbucks cursing under my breath.

In exactly 19 minutes I was defeated but slightly more caffeinated and crabbily asked for my form. And then that malicious troll tells me “2 more minutes”. This was far too much for my over-caffeinated sleep deprived and emotionally labile brain. I started to wildly point at the massive digital clock in front of the department that said 0800 and demanded that my form be print. He then pointed to his clunky analogue wrist watch and said, “not according to my watch”. Standing there for 2 minutes, I watched him calmly sip his coffee and smear icing over his keyboard and thought to myself that I would exact payment from him a hundred fold if I ever got the opportunity. He finally opened the application, asked for my employee number and last name and gave me my form. Feeling livid yet helpless I asked him why he couldn’t have just done that for me 20 minutes ago. “You’re not special enough to break rules for” was his curt reply.

I stormed out of the department, got home an hour later than I normally would have and ate a giant bowl of rice to try to silence the fury within. After a hot shower and a long nap, my encounter with the evil HR troll became nothing more than an irritating memory.

However, on rare occasions, karma works in my favour. On my next set of shifts, the very same troll was in the waiting room and triaged to fast track for flank pain. He looked visibly uncomfortable while I looked positively overjoyed. When I went out to the waiting room to introduce myself and to bring him inside the department, he didn’t initially recognize me. But boy oh boy did that change fast! Normally I use a 20 gauge angiocath – he got a 16 gauge (it’s a much fatter IV needle). He then started to look at me as if he recognized me (and wronged me) but wisely kept quiet. Perhaps he was cursing his dumb luck and was hoping that I wouldn’t remember him. Fat chance buddy. Fat chance. He was ordered 4-6 mg morphine q4h prn. I normally push morphine but for him, I made a cute little mini-bag and let it drip slowly. I kept an eye on him but in 3 hours he asked for another dose. The satisfaction I felt in telling him that he would have to wait exactly 57 minutes for his next dose while watching his face contort in agony and horror was beyond anything I can articulate. After 57 minutes had passed, I took my sweet time in setting up another mini bag. A better person than me would have let the entire thing go. A better person would not have had this to blog about.

So let this be a lesson to evil HR people who don’t take mercy on night shifting staff – vengeance will be sought and you won’t enjoy it one bit!

A Chief Complaint with no Easy Fix

2009-09-26T02:28:00.003-04:00

Chief complaint - back pain. In fast track it’s a fairly common, slightly irritating (if the person is a known drug seeker) but mostly benign chief complaint. Not last night. I picked up a chart from triage and read that the patient was a 27 year old woman presenting with back pain. On first look she appeared to be quite well – there weren’t any exaggerated displays of agony, her gait was steady and unremarkable and she denied any parasthesias.

“So what is it that we can do for you?” I eventually asked.

“I need a referral to a plastic surgeon for breast reduction surgery because my back hurts. And if I can get it done this week, it’ll give me enough recovery time to wear a strapless gown on my wedding”.

Shocked and mildly amused at having to ‘work up’ this patient, I just had to ask why she chose 0400 to come into an ER to ask for a plastic surgeon for an obvious non-emergency.

“Umm hello, wedding” she told me in a tone that suggested that I was not only an idiot for asking something so obvious, but that I should lose my license for failing to grasp a fundamental truth about the importance of being able to fashionably wear a strapless gown on one’s wedding day.
In the end, things took their expected course. She was sent away because we could not provide the care she was seeking. She was visibly upset at not being referred to a plastic surgeon right away (they like to sleep at 0400) and left with well vocalized thoughts of malice for us all.

Notwithstanding the behemoth that is the wedding industrial complex or the frenzied feelings of insecurity about one’s looks in a world where one’s every movement can be photographed (from every imaginable and unflattering angle) and be posted on facebook within minutes, I still think trekking it out on a cold night to go to an ER in a hospital whose specialty is oncology and cardiology to ask for a plastic surgeon is bordering on downright irrational.

Despite the fact that she was a complete bitch to me, a part of me sympathizes with her. I know I’ve spent an entire day getting my hair and nails done for a casual get together and bought an insanely expensive item of clothing to try to silence my own inner critic. She too is trying to achieve her vision of perfection but I do hope she wakes up out of her wedding induced fog and pursues breast reduction surgery to enhance the quality of her life as opposed to quality of her photographs.

Grunge Work and an Unlikely Source of Help

2009-09-19T00:30:00.002-04:00

One of the staff docs that I work with is a fairly reserved guy whose demeanor can be mistaken for snobby or stand-offish. He’s not mean per se, but he gets irritable fairly easily. He’ll never throw a hissy fit at any of the staff, but rather just mutter quietly to himself when doody hits the fan. He’s not exactly friendly, but nor is he unfriendly – he’s just quiet. He always lends a hand where needed by whoever without being asked. And he’s scary smart. Sometimes, I like to pretend that I’m documenting furiously when in fact I’m listening to him teach the med students and residents because he explains concepts so clearly that even in my most twitchy sleep deprived state, I manage to learn and retain the new knowledge. Having said that, he would not be the first person I’d ask for help for something trivial – I just don’t feel very comfortable around him. However, he completely surprised me during my last shift.

I had a fairly heavy patient who was hypoxic and was well on his way towards delirium. The patient was a HUGE guy and he needed a boost up in bed. As crazy as I can get, even I knew that if I even tried to lift him myself, my back would seek vengeance on me for years to come. So I did what any nurse does – put the side rail up and trolled the department for an extra pair of hands. That’s when the doc asked me, “what do you need?” Stuttering, fumbling and with some fairly elaborate gestures, I manage to tell him that I need to boost hypoxia/delirium guy up in his stretcher and get him comfy. The doc starts to head towards the patient’s room and tells me that he’ll give me a hand with the boost. Confused, yet relieved, I started to follow him. When we reached into the patient’s room, the patient had spilled his water and jell-o all over the linens, which meant that now I had to change his gown and linens as well as boost him up in bed. When I turned around, the doc had left the room. Just as I was about to silently wish a pox on his house and mentally assemble a shopping list of materials I would need to construct a voodoo doll in his likeness, he walked in with fresh linens, some more water and jell-o as well as the patient’s next dose of antibiotics (which were properly mixed AND labeled). Not only did he help me with all the grunge work, he sat down with the patient for the next 20 minutes trying to reorient him back to reality while I arranged follow up appointments for another patient.

I never did get a chance to thank him for his help since that quiet period was sadly the eye of the patient influx storm. Not that he’ll be reading this blog post (or at least I really hope not), but I was thoroughly and pleasantly surprised at how he was willing to lend a hand with the less glamorous aspect of patient care instead of sitting on the sidelines and telling the charge nurse that the patient needed to be tended to. Dude totally gets team work. I still won’t be asking him for too much help though.

Killing me with Kindness

2009-09-17T15:37:00.001-04:00

There are those patients who are rude, demanding, entitled and prone to screaming temper tantrums. Those patients are fun to (figuratively) bitch slap back into place and/or throw out of the department. They are also fun to blog about because they showcase the scummy depths of immaturity to which people can sink when their demands are not immediately met.

Then there are those patients/families that on first impression seem to show genuine understanding about wait times and how busy the department can become and for a while, they leave you alone. And then the call bell starts ringing. You go into the room with high hopes of all being well. Turns out the patient wants an extra blanket. “Sure, no problem” you say as you bring one fresh from the blanket warmer. “Those rooms are chilly” you think. “Anything else while I’m here”, you ask. “No dear, that’s all, thank you”. You get back to doing whatever it is you were doing, and then the call bell rings again. You go back into the room and this time, they’re asking you to readjust the telemetry wires because they’re uncomfortable. You do your thing, give the patient a winning smile, do a quick little assessment and then leave. Then the charge nurse brings a new patient that will take up some time and sure enough, the call bell goes off again. “Please dear, can you tell me how much longer will it be before I see the doctor?” The department is swamped (as usual) and you tell them once again it’ll be a while but in the meantime, they’re being carefully monitored. “While you’re here, can you get me another blanket? Also my IV is feeling uncomfortable. Can you bring me something to read? I’m really hungry as well – do you have any dinner trays? How long could it possibly take for the doctor to see me? All I want is a quick little x-ray and some medications” And then you think, “I’m so fucked – this is going to go on for the entire shift”. You also realize that you should have set limits waaaaayyyy long ago when they first comfortably ambulated inside their room.
When you actually can’t answer their bells, they get extremely upset and use all available tricks up their sleeves to make you feel like you’re scum for not holding their hands through their terrifying ordeal when in reality you’ve got 5 other patients and ever increasing amount of orders that you have to carry out so your entire team doesn’t chew you out for slowing down patient flow. Finally you have to put your foot down and tell them to use the call bell for emergencies only – holding the urinal in place while I have to be the third party listening to a detailed cell phone conversation about how the new son-in-law is a complete schmuck does NOT qualify as an emergency.

The entire encounter reaches a disheartening conclusion when the patients and families want to speak to the charge nurse about how their reasonable requests were ignored throughout the length of their stay despite the fact that a nurse was in their room almost every 45 minutes. “At least I documented really well” you think as you trek it to Starbucks for yet another latte after having downed an Advil. Some days, defeat is inevitable.

Zonked Out

2009-09-10T21:18:00.001-04:00

Completely unorganized? Check.

Abnormal sleeping patterns? Check.

Lapses in short term memory? Check.

Occasionally slurred speech? Check.

Extreme irritability at neighbours who are rebuilding their deck? Check.

Are these symptoms of a stroke? I really hope not! However, I feel like that for the past two weeks, I’ve been completely and utterly ‘out of it’. I can’t seem to sleep at a normal time, can’t get up before 1400-1500 in the afternoon, feel tired and groggy and can’t pay attention to what happened several hours ago, let alone several days ago. Friends are telling me that I’m anxious about my upcoming performance appraisal, but I’m going to disagree. My completely untested theory is that since I force myself to be hyper-alert and vigilant at work, my mental status takes a 180 turn and I completely zonk out when I’m at home. I think the pinnacle of zoning out happened when I watched 6 hours straight of True Blood with my sister and then promptly fell asleep. As soon as I snap myself out of this funk, I’ll write a proper blog post.

On another note, I’ve officially been a REGISTERED nurse for exactly a year today. How freaky is that? Some days I still feel like a nursing student (albeit with a slightly less emaciated bank account) who’s been wrongfully handed responsibility! And check this out - http://www.rncentral.com/nursing-library/careplans/life_in_er_50_best_blogs . All I’ve got to say is thanks so much for paying attention to my little corner of cyberspace :)

Organic Bitterroot Juice is not an Approved Treatment for HHNS

2009-08-31T21:39:00.001-04:00

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

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

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

Abusing STAT

2009-08-23T13:52:00.001-04:00

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

Lytes, BUN, Cr, Glucose – STAT

ECG – STAT

Trial clear fluids – STAT

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

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

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

If You Can’t Take the Heat…

2009-08-17T02:04:00.001-04:00

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

Why I’m in Love with Vincent Lam

2009-08-11T22:55:00.003-04:00

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

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

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

Generalized Mean-Spirited Disorder

2009-08-05T17:17:00.002-04:00

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

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

I'm Tired

2009-08-03T17:10:00.002-04:00

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

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

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

Heart Health in Action

2009-07-26T22:59:00.002-04:00

After explaining atherosclerosis, cardiovascular fitness, weight management and the importance of maintaining a diet low in cholesterol to my old country non-English speaking relatives, my sister and I scurried out of the door like rabid dogs as soon as we heard the siren song of the ice-cream truck and returned with ginourmous cones of ice-cream that probably had 2 days worth of calories. Our display of unrestrained gluttony was met with sharp disapproval as ice-cream melted onto the carpet. We’re soooo smooth.

When Your Timing Sucks

2009-07-25T03:03:00.000-04:00

Lately I’ve been getting patients who suddenly remember all of their outstanding medical concerns AFTER they’ve been seen and discharged! Last night, three of my patients started causing a ruckus over needing various scripts* to tide them over until they were able to see their family doctor. I fail to understand why they would not ask the doctor about their medication concerns when the doctor is actually seeing them rather than sauntering up to the nursing station 30 minutes after being discharged and then casually asking for scripts from the ward clerk or the nurse. I do not enjoy having to needlessly argue with a patient especially when I’m juggling a full area because the patient thought, ‘hell I’m here, might as well take care of ALL of my inane errands’. I’m also pretty sure that our docs don’t like being confronted with an eager pen holding patient who they thought was long gone asking for a script. I realize that sometimes patients forget to mention things to the doc because the entire department seems to be rushing, but it’s called an EMERGENCY department, not the WALK-IN clinic.

*Not narcotics – those are a completely different issue!