Saturday, October 30, 2004

I'll get to it, I swear.

Sorry, kids. I just don't have the energy today to deal with The Types of Nursing Student. Maybe next week.

Beekeeping, or odds and ends cleared up

GruntDoc has noticed that I don't have a description of ED docs in my guide to specialists. As I told him, I'm depraved on account of I'm deprived--our hospital, being referral-only, has no ED.

However, I'm sure that ED guys and gals are uniformly the most attractive, most talented, most charming, and most tasteful doctors of them all.

I've not written lately because my arm is acting up. I have an old case of ulnar neuropathy that doesn't take kindly to typing, though it'll handle cooking just fine. The result is that I've made a huge salad to last the week and baked some apples today.

The rash is better, thanks for asking. Not gone, but not as leprous as it was.

Head Nurse: Now With More Poop

I got a request via email for more poop and mucus stories. (You know who you are.) Therefore, I present to you the Worst Poop Story of Them All:

A young man with a high cervical injury was admitted to our floor by the PM&R doc that sees him most often. His diagnosis was fecal impaction: not unusual in spinal-cord-injury patients, as nothing below the level of the injury really works as it ought to. Even daily bowel programs don't always do the trick.

This kid was scheduled for a colostomy to reduce the need for occasional admissions for disimpaction. Problem was, he hadn't had a normal bowel movement in something like six weeks. He'd been having *daily* bowel movements, but not enough to keep him from....well, from backing up.

On assessment, the guy had a distended belly. Let me rephrase that: He looked like he was ten months gone with quadruplets. Bowel sounds were almost normal all over except in the lower-left quadrant. He complained of a lack of appetite and difficulty breathing; not surprising considering what he was dealing with. His belly was tympanic to percussion. (In English, that means it went "bomp bomp bomp" like a drum when I whacked it gently.)

His doc decided to try the gentle stuff first: a couple of doses of Sennakot over a few hours, digital stimulation, and see what happened.


So she went to two bottles of magnesium citrate and digital stim.


Enemas. Nothing. More mag citrate. Nothing. Further doses of laxative. Nothing.

Finally, I called her just before shift change and asked permission to coordinate with another nurse who worked nights and simply do our worst.

So James and I went to work in tandem, him on nights and me on days. Our poor distended patient got a couple of Triple-H enemas (high, hot, and a hell of a lot) and a gallon of Go-Lytely, given in a dose of fifty cc's every ten minutes. (In a case like this, you want to work from both ends and not dose the person too hard with Go-Lytely, lest something bust open.) In the morning, he got yet another enema and some more mag citrate, drunk slowly and carefully.

About two o'clock in the afternoon things started to happen. By four his belly was soft and nontender, its normal size, and we'd all had three changes of clothes. It ended up being easiest simply to hold him up while he sat on the regular toilet--not the bedside commode--and flush every thirty seconds or so as he sat.

Some medications dissolve through their capsule, leaving their shells--the actual tablet or capsule part that you see--intact. He had literally hundreds of those backed up in his colon. That should give you some idea of what our day was like.

If the government is ever looking for a cheap, easy way to put people into low-earth orbit without a spacecraft, I recommend magnesium citrate and a hose.

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