Wednesday, August 31, 2005

*sigh*

Everybody I know in NOLA got out okay, 'cept one friend had to leave her horse stabled about 45 miles north of the city. I woke up this morning to hear an interview with a man whose biggest worry was the three cats he and his wife had to leave behind when they evacuated. *That's* a buzzkill.

*sigh*

My easiest patient yesterday was the one with blood pressure problems, sugars that ranged from 21 (0700) to 538 (1730), a half-inch thick clot the size of the palm of my hand covering her incision line (the order read: "Shampoo patient's hair and remove clot covering incision." Three hours of H2O2 later, I'd gotten an inch square chipped off), a crazy husband, as in paranoid schizophrenic not on meds, and incontinence of bladder and bowels (the order read: "Do not diaper patient." I guess they were worried about skin breakdown?).

Then there was the guy with the leaking scalp incision who kept throwing PVCs on the monitor. For non-medical types, the heart has its own electrical system, independent of the rest of the body. Sometimes the ventricles (the big chambers at the bottom of the heart) will Contract Prematurely, leading to Premature Ventricular Contraction, or PVC. This is a bad thing if it happens more than, oh, eight times in a row. Like the heart will get its electrical signals all flummoxed and, well, have to be shocked.

I showed the EKG tracing to the PA, who was unconcerned. The damn thing looked like a test strip you'd get on the NCLEX, but PA-Man just shrugged and said he was aware of it.

So I parked the code cart outside that patient's door.

Add in two lumbar drains, a post-angiography patient who kept leaking, and Doctor Asshat, who yelled at me for something that I had nothing to do with, and you have a typical day. Oh. I forgot about the 410-pound patient with the shoulder scope who needed pain medicine every hour.

It got bad enough that, as Dr. Asshat revved up in his bitching, I slapped my hand flat on the chart he was writing in, leaned forward, and hissed "I am trying to make your job easier. Do not bitch at me about policies that I did not write."

It's nice to be considered the Go-To Girl when people are having crises. Even when I'm working sick and putting out only about 80% of my usual effort, that's still better than a lot of people's 100%. Really. Still, it's *not* so nice to be such a go-to girl that I end up with six complex patients when other nurses are carrying three. Especially when two of them are Dr. Asshat's and the third belongs to a resident who's unwilling to write the orders necessary to get things done.

Chef Boy asked last night "Again, why are you doing this? Wouldn't you rather be in a lab somewhere?"

Sometimes I would. It's not the patients that get me; it's the doctors.

13 comments:

anne said...

The doctors. That's kind of what I'm worried about. (I'm Anne, who just posted to one of your later posts telling you I'd started nursing school...)

I'm (re)taking A&P, as I last had it in 1991... and my prof is A Physician. I would only know that because he has mentioned the fact at least half a dozen times. Also - he's an ass. A complete and total ass, in pretty much every sense of ass-ishness - except for the funny and ironic fact that he *has* no ass. I find that part amusing. I think that my biggest problem in medicine may indeed be the doctors.

That being said... working in a lab? Not so much fun. That's been my profession for many years now, and, while it's probably better in terms of more human-oriented working hours, it has its own special set of frustrations. Anytime you feel the need to go in that direction, ask me for the pros and cons!

Anyhow... email is alr62@cornell.edu if you ever want to chat.

Thanks for writing such a fun, interesting, sharp blog.

--anne again.

Anonymous said...

Some people have chlidren that they love and others have animals they love--forget your buzzkill, and remember peoplehave different things that they love and are important to them. They assumed responsibility for those lifes and have appropriate concerns. You should understand, since you assume responsibilty for your patients lives during your work hours. NO ONE LIKES leaving a loved one behind, animal nor human. Have a heart.

shrimplate said...

You know that Albrect Durer engraving of "Melancholia?" The angel chained to the ground?

Well, that angel was a nurse.

Jo said...

Yo, yo, Anon! You got me all wrong.

When I say "buzzkill" I mean it as shorthand for "that was the thing that sent me over the edge and back to bed, crying for this poor man who was so worried about his cats."

I could not imagine leaving Miss Kitty, She Who Eats Feets behind me for any reason. My heart broke for the guy who had to do it.

Sigh. I guess Noah's Wish (noahswish.org) will be getting a lot of donations this year; they'll need them.

It's bad enough that people were hurt. For some reason (and here I'll piss somebody else off), the thought of animals being frightened and injured bothers me more, maybe because they can't possibly understand.

Barbados Butterfly said...

Mmm, not all doctors are bad, although I know there are many out there that would make a good nurse want to slap them.
This week one of my senior consultants was assessing a woman's wound after a mastectomy and rather than saying "the wound looks excellent, there's no swelling or collection", he told her said "that's great, it's as flat as a tack".
Still, some of us doctors understand that we're part of a healthcare team and that nurses are very important members of that team. Yesterday after I spoke to a woman's daughter about her mother's new diagnosis of incurable cancer I made sure that I told the nurse exactly what had been communicated and what was happening, including that I thought that the woman's increased morphine doses may well (combined with her Alzheimer's) increase her falls risk, make her confused and exacerbate her intermittent aggressiveness. (These effects of morphine may be intuitive to some nurses, but I find it better to state the obvious as it would be silly of me to expect grad nurses to read my mind). I always try to ensure that I keep the nurses up to date with plans about fasting status and timing of procedures as they change and that prn meds are written up before they are needed. I encourage my resident to write up fluids on the morning ward rounds so that nurses aren't having to chase him later. When I was a resident I would occasionally get called about patients who weren't my own when the head nurse knew that the resident who was treating them wasn't managing things properly (or was ignoring the nurses) and that the patient was deteriorating (eg giving phone orders for ventolin nebs in an wheezy 80 year old man with CCF whose usual meds of lasix and carvedilol have been withheld for 4 days). This year the nurses on my home ward asked me to come urgently to treat a guy who I'd previously treated but who wasn't under my care, as his SaO2 on 15L O2 was 85% and they couldn't get the intern or patient's registrar to answer their pager. I went - any senior nurse who says "I'm really worried about him and I can't get anyone to come" obviously needs a doctor pronto. The crash cart was stationed outside the room and when we couldn't improve things quickly with CPAP, frusemide and GTN I called a Code Blue and we had a controlled transfer to ICU. The patient did well afterwards, although at the time he looked quite grey and I thought he might arrest or need intubation.
I think if you abuse the nursing staff you're abusing your patients. Sorry you've got duds as your doctors, I hope there's a rotation change soon.

The Lioness said...

I absolutely agree w anon and cannot fathom, for the life of me, how the person whose blog I've been reading and enjoying so very much for so many months now is the same one who could write something so callous.

The Lioness said...

Oh and then I read the new comments, THANK GOD! I apologise for thinking so ill of you, I was truly having the hardest time reconciling the You I've been reading with the You who could write that. I feel exactly the same way abt the animals, absolutely. I've donated to alleycat.org already, they are being flooded w emails from owners who do not know what to do.

geena said...

"I woke up this morning to hear an interview with a man whose biggest worry was the three cats he and his wife had to leave behind when they evacuated. *That's* a buzzkill."

I knew what you meant. As much as my heart breaks for the people that are there, it breaks just a little more for the animals. There was something on the news last night where a guy tried to give this dog stranded on the road some water, but the dog was so frightened that it just growled and barked. Even though the guy left the water there and watched the dog for awhile, he said the dog never drank anything.

Breaks. My. Heart.

Noran said...

I apologize for my previous post. I am Anon. I have made several donations to red cross and will be making a donation to Noah tonight.
Different people have different definitions for the same word. This situation makes all of us nurses very emotional-we want to be there, and we know our presense could make a difference and save lives, but we aren't allowed in. I mean, Charity hospial not evaced for almost a week, mad me cry, though Tulane, a private hospital across the street was evaced on thursday.
A little boy being put on a bus to Texas was made to leave his dog behind, he cried so hard he started to vomit.
Again I apaologize for any and all hurt feelings I have caused, for I am glad to find we are on the same page. I pray every night falling to sleep with tears in my eyes for all those affected.

HypnoKitten said...

I knew what you meant when I read that, Jo. I've been reading for a while now and I know your love of animals. It would break my heart to leave one.. and for that reason alone I'd probably be among the first to evacuate if I could - knowing full well that if worst came to worst they'd rescue me and leave pets behind.

Because I love cats, I also think of the kitties who are so much like little children and don't know where their moms and dads went...

cathyf said...

My mom has a favorite story from her first year out of nursing school (would be about 1958.) She was working nights, and because of staff shortages it was just her and an aide for 2 floors. Basically she did the whole shift at high speed. At one point a patient thought that she was having an asthma attack, so my mom grabbed her some sort of suppository (not sure what -- hey, I'm an engineer). As she hustled back to the patient's room the woman was very relieved to tell her that it was a false alarm, or the attack had passed quickly. My mom didn't have time to put the suppository back so she stuck it in her pocket and went on to the next crisis of the night.

Several hours later one of the residents (who was not normally an asshat) chased her down because something not particularly important had not been done for one of his patients. He had a complete screaming meltdown in the hall (which of course was taking time my mom just didn't have right then...) She listened to it for awhile, with her fists clenched in her pockets. Then he paused for a breath, and my mom reached out her hand and said, "Here." The doc, reacting automatically, reached out his hand. Mom turned and walked away as he stood there gap-mouthed staring at the suppository in his palm.

He came by about an hour later to apologize...

cathy :-)

Allen said...

HN,
you really need to discuss the behavior of Dr. AH with the nursing supervisor. Basically, we have some docs who aren't as nice to the staff as they should be, and 'everybody's got a boss'. Usually the ones who can get things to happen with docs are senior administrators, who have a lot more options available to them than you'd imagine.

Really, you're doing what you can directly, now it's time to let the System Help You.

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