Thursday, June 23, 2005

Sudden moment of self-doubt: am I still cool?

Hate Coldplay.

Bored by Tom and what's-her-name. (Speaking of which, recent research has shown that certain "important" faces might be stored in a few brain cells devoted exclusively to that purpose in our brains. Thus, we have a few brain cells devoted to Halle Berry, a few devoted to Robert Gould, and so on. Which depresses me. Any number of brain cells devoted to celebrities is too many.)

Love political discussions.

Two vintage painted Mexican tourist skirts in closet.

Hair sticks up all over head without my trying.

Two holes, one in each ear, no tattoos. (Wimpy, wimpy, wimpy.)

Screamingly liberal, still.

Thinking of taking back old part-time job as family planning counsellor at Planned Parenthood.

Can quote lines of poetry.

Make kick-ass mac & chee.

Share that recipe with the world.

Thirty pounds overweight...
...but boobs not yet hitting waistband of jeans.

Excellent intuitive diagnostician, paranoid nurse.

Consumes gallons of Scotch. Neat.

Just commented on 18-year-old's blog. For the record, she writes *hilarious* stuff. Much funnier than my best efforts.

Yeah. I'm still cool.

Whoring and hobbying.

Food whoring and hospital hobbying, that is.

Remember the corn I got? I got more from the farmer's market and mixed it up with black beans and diced tomatoes and some broth from the Dead Chicken of the other night (this was older corn that could be treated this way) and made SOUP. Mmmm. Soup. (There, Kit, is your Corn Whoring.)

As for the hospital hobbyist, here's the story. It's instructive to note that all the time the residents and attending were writing orders, we the nurses were the ones that had to deal with this patient.

Every once in a blue moon, you meet a person with an incredible tolerance for pain medication. For those of you who aren't nurses, the Painkiller Of Choice for a lot of people with a high tolerance or a big addiction is something called Dilaudid.

Whereas morphine and Demerol are dosed in milligrams, Dilaudid is dosed in tenths of milligrams. It's not only whoppingly effective, but it's whoppingly concentrated. Keep this in mind: a patient-controlled pain pump filled with morphine is dosed one milligram of drug to one milliliter of fluid. Dilaudid is dosed 0.2 milligrams of drug to milliliter of fluid.

With addiction (I'm not going to use the word "tolerance" here, since it's not appropriate) comes other problems, most of them psychological. Sometimes it's bad enough that our very-pampered MDs will skip seeing a patient daily, just so as not to have to deal with their weirdness.

Which brings me to the Champion Hospital Hobbyist: a person who spent six weeks in our facility with a wound infection, who was on a Dilaudid pain pump with a setting I had to read twice to believe, who got additional narcotic painkillers and Dilaudid boluses every hour, and who still was able to get up, go down seven stories, walk out to the parking lot, and smoke.

(For the nurses, the pump setting was 0.4 basal, 0.6 q 6 minutes, 30 mg q 4 hour lockout, boluses q1 prn. Which was increased every few days as boredom set in. Along with fifty of Phenergan q2 and the occasional Lortab.)

This patient was crazy enough that the attending had left it to the residents and nurses to handle things for six weeks. We were all wondering if Said Patient was simply going to move in, since there didn't seem to be anything wrong that we had to deal with, when I finally asked Attending the burning question on everyones' minds:

"So...this person's been here a month and a half, and we haven't really done anything. How many nudie pictures of you *do* they have at home? 'Cause that's the only reason I can imagine that we're keepin' 'em."

Champeen Hospital Hobbyist was gone the next day.

Sunday, June 19, 2005

Boy, I wish I had a dog.

Four a.m., I've been up for an hour, and today will not suck.

I woke up an hour ago to the sound of drunken shouting and the screeching of tires in the parking lot. Where I used to live, this would not be an issue; in fact, it was a normal part of daily life. A car landed in our front yard about once every two months, propelled by somebody who'd already had too much to drink and who was looking to beat closing time at the closest liquor store.

But here it's odd to hear yelling at 3 o'clock in the morning. Or any time, for that matter. So I was wide awake, listening for running footsteps or gunshots or screams, when the Great Dane next door started to bark.

Woof. Woof. Woof.

Nothing frantic, nothing hysterical. Just the thoughtful, measured "woof" of a dog that outweighs the people it lives with.

It struck me simultaneously that not only would a Very Large Dog be a good thing to have, but that anybody who keeps a Very Large Dog in a thousand-square-foot, third-story walkup apartment is dedicated in a way I can't even imagine.

Anyway, having the big guy next door makes me feel safer. Knowing that he's going to produce a subsonic "woof" at a disturbance dozens of yards away makes me feel better about somebody trying to get in here.

Why today will not suck

As any nurse will attest, there are some weeks when you lose track of time completely. It's a sad day when you have to depend on your patients to reorient you to date and time, but it happens. I had the sudden, horrible conviction that I actually had to work today, and had to go check my calendar to see if I was right. Nope. No working today. Which means farmer's market and natural food store and nap.

Speaking of which, I found something remarkable at the grocery store yesterday. Corn was two bucks for five ears, so I bought five, intending to prepare it somehow for dinner last night. When I shucked the first ear, I discovered that what I'd bought was perfectly ripe white corn with tiny, sweet kernels. So I cut it off the cob, steamed it in the microwave for three minutes, and dressed it with butter and salt and pepper. Yum.

Enough foodwhoring. Kelly wants to hear the story of the hospital hobbyist who spent six weeks without seeing a doctor, so maybe I'll tell that one later. Right now it's time for leftover dressing and gravy and another cup of joe.

Saturday, June 18, 2005


Roast chicken. Stuffing with pecans, mushrooms, and onions. Corn off the cob (not sure if I'll steam it or cream it). Carrots. Potatoes, maybe scalloped. Cherry pie.

Who wants to come for dinner?

Friday, June 17, 2005

No, Speed Racer, no.

His legs were already over the bedrails by the time I got to him.

"You'll have to wait a minute to get up until I get your walker" I said.

He tried to get up anyhow. He's not demented or confused, just convinced that his seventy-eight-year-old, six-foot-eight, three-hundred-pound body works as well now after back surgery as it did before. The two-foot-long incision might give the lie to that.

He got to the chair, let go of the walker, and plopped into the chair with one buttock on the chair arm.

We had a little discussion after that. He'd fallen the night before--sitting down hard on his ass after getting out of bed despite raised siderails and a bed alarm.

"Look," I said, "you *have* to wait until I get in here to get up. And you *have* to use the walker correctly, or else you will fall again and have another surgery. If you fall, I'm not even going to try to catch you. I'll just get out of the way."

"You won't try to catch me?" he asked, disbelieving.

I looked up at him--he's still taller than I am, even when he's sitting and I'm standing, and said, ""

Tell me where these people come from so I can shut the gates.

Monday, June 13, 2005

A happy customer service story

So I ordered some clogs from The Clog Shop. Dansko Sport clogs are the only type I can wear; the Professional line has too narrow a heel, and I fall over a lot.

Today I got a call from a very nice man at the store. Seems the clogs I'd ordered were only available in white, not black. They'd gone to the trouble of tracking down one of the only remaining pairs of another style that's practically identical. The store sending that pair to *them* wanted to get a C.O.D and charge them $20 in shipping.

The Clog Shop guys offered to eat half the shipping and charge me the other half. Since their shipping is already free, I said "Hell, yeah!" I now have two pairs of Dansko Sport clogs on their way, thanks to the smart people in Great Neck.

I believe strongly in shopping Mom & Pop places rather than El Giganto Box Stores, and this is why.

Friday, June 10, 2005

You know how "they" say

Never to eat shellfish in a month with no "R" in it?

Well, they're right.

The shellfish-induced nightmare I had last night might've had more to do with the fact that the shellfish came from the seafood equivalent of the Little Guy With The Cart With Bells On It Who Sells Tamales. Eugh. Still, I'm not chancing it again.

Normally I'm not a huge fan of Filipino food. The dried fish is good, though rich, and the eggplant has its place, but I just can't get behind the little cakes that might be sweet or might not be. The mussels, though. Mmmm, the mussels.

From the mussels came the dream I had: I was catering a wedding in Chef Boy's absence, but I was doing it *in the hospital*, and nobody had ordered food that week. Which meant I had to deputize someone to handle washing all the dishes and someone else to go for groceries while I watched fourteen patients who all had odd rhythms and ectopy on their monitors.

Never again. I get enough of that stuff when I'm awake. No need to do it when I'm asleep as well.

Thursday, June 09, 2005

Quick shout-out to Em

Who rocks my world for explaining how to make my sidebar look ept once again. Its ineptness had been bugging me.

Little did I know that she's also a student nurse and a writer, and a good one at that. So go check out "Where's My Towel?" over thar.

For my nice pal from Digitalstakeholders-dot-org...

I cannot fathom the rationale for a so-called "critical nursing shortage" in light of your postings.

God love him or her; s/he's brought out my soapbox.

I paint a really rosy picture of being a nurse. Most of the nurse bloggers I know do; it's because we have the time and energy to blog because we work in good facilities. But there *is* a critical nursing shortage--and don't let the word "critical" make you think that everything that follows it is hyperbole. It's not.

The facility where I work is private. It's famous all over the South for the work that its surgeons do. It's one of those places where you meet doctors from all over the world who've competed hard to gain fellowships. We recruit nurses from all over the country, from some of the finest nursing schools around (both two- and four-year; we're not snobby that way).

As much as I bitch about the administration, there are certain things that are unique--and wonderful--about the place where I work. The attending physicians have nicknames. Nobody is verbally or physically abusive. The patient-to-nurse ratio is quite low. The pay is good, the support staff is smart and competent, and teamwork is emphasized.

I've heard stories from non-nurse friends that chill me. One woman told me about going to visit her mother in the hospital and seeing a nurse punched by another patient's family member. I've been told about doctors screaming obscenities at nurses in a patient's room. And I've heard one story from a pal about the hospital her father was in--the place was so badly controlled that he was beaten up by his roommate.

The stories from nurses are even worse. One woman I precepted as a student nurse accepted a job with a fairly prestigious hospital and got a three-week orientation (ours is twelve). On her first day as a brand-new nurse, she got nine patients. Nine. With no practical nurse to work with, no patient care aide, nobody. I hear stories from colleagues of sixteen or more hours of mandatory overtime a week, or worse, of being so overwhelmed that your charting isn't done until three hours after your shift ends.

No wonder there's a nursing shortage. You know the shortage is bad when Our Beloved Governator, Arnold, calls nurses a "special interest group" because the unions had the temerity to fight for safe nurse-to-patient ratios.

We're at about a ten percent vacancy rate across the country right now when it comes to floor nurses. Critical care and specialty vacancy rates are even higher. (Don't even ask about rural and deep-urban shortages.) We just aren't graduating or keeping enough nurses to staff the hospitals we've got; at the same time, we're having to build new hospitals to keep up with demand.

Part of the problem is in nursing schools. Teaching positions pay shit, compared to working on the floor, and the hours are even longer than those of floor RNs. There aren't enough teachers to go 'round, so there aren't enough spaces in nursing schools. My class started with thirty (out of 228 applicants) and ended with 21--not a bad attrition rate, if you think about it, but a horrible acceptance rate.

Part of the problem is with nursing curriculum. Especially in two-year programs, the workload is insane and the competition horrendous. Medical residents go through an eight-year weeding process to cut out the dead wood; we get two years. A couple of my colleagues graduated with less than a third of the classmates they started with. This is one of those necessary evils: if you're not quick enough, smart enough, and strong enough to handle the schooling, you're not going to be able to handle nursing.

But the main problem--the thing that is solvable but unsolved--is the fact that hospital administrations see nurses as a homogenous group of masochistic machines who'll do anything for a three-thousand dollar signing bonus. Money rarely gets put aside for continuing education, cost-of-living increases, or special awards. Nurses are unrecognized, on the whole, and expected to take on ever-more-critical patients with ever-less-available resources.

And hospital CEO's, like CEOs all over the country, make gazillions of bucks. Consultants get hired to tell hospitals how to improve customer service (ignoring the best way to have happy patients--have happy nurses). New hospitals get built with all the latest bells and whistles, then offer only 80% of market rate, thinking that nurses will be happy to get taken for a ride, as long as they get all the greatest technology.

So yeah, beloved DSH, there is a rationale there. And the shortage is critical *right now*--maybe not across the entire country, but it's certainly dangerous in spots. (One of our sister hospitals has *two* nighttime RNs for its orthopedic unit.)

Now I'm going to put the soapbox away, thank heaven for my job, and go get some coffee.

Monday, June 06, 2005

HTML Nurse...

Okay. I've added to and rearranged links on the sidebar, a task that leaves me shaking and sweaty.

For you Safari users, Ivo's blog sponsorship is probably still taking up way too much space--sorry. I've gotten ahold of Ivo's tech guy but have heard nothing back yet. (Hey, BEN!! I'm callin' you out in public, man!!)

No, I don't know why there are big spaces between headers and the first links under "Nurses" and "Docs". I also don't know why things changed color. I am an Aitch-Tee-Em-Ell Idiot. Anybody want to help me out, email me privately. I'll take good care of you if you ever end up in the hospital.

Sunday, June 05, 2005

Things I like

In honor of having three days off in a row

Making up new lyrics to Pussycat Dolls music: "Don't you wish your girlfriend was as brilliant as I am?/Don't you wish your girlfriend was as smart as me?/Don't you wish your girlfriend was a specialist RN?/Don't you wish your girlfriend had a PhD?"

Having three days off in a row.

Cheese fries and a leetle nightcap at the restaurant I favor, when everyone else is done. Bartenders are interesting people.

Running/trotting three miles at once and not dying.

Clean sheets.

Clean scrubs, all at once.

My cat, just in general. She's insane (Janet The Writer heard me cuss at her more than once on the phone, poor woman) and cranky, but I love her.

Speaking bad French to people from Louisiana who speak good French.

Air conditioning. That should probably go up at the top of the list, given what the weather's been like lately.

Big giant dogs. As in 180 pound Great Danes and big ol' English Mastiff puppies that weigh almost as much as I do even though they're only nine months old. I'm crazy about big dogs, much like Audrey was crazy about Tiffany's.

Vacation plans. Practical jokes. Waiting in the airport for my flight to take off. Silver pins. Polish stoneware. Blonde jokes. The first scene of Episode Three. Going to bed early.

And so, Goodnight.

Swear to God, I'm gonna kill somebody one of these days.

Not in the medical-malpractice sense, either.

One of the weird things about nursing is how dichotomous it is. One week, you'll get patients who will actually use their incentive spirometer (a fancy name for a widget one breathes into to keep the lungs healthy), walk when they're supposed to, and generally work at getting out of the hospital. Their families will be understanding and kind, and the doctors will respond to pages.

The next week you'll get people like I got this week.

Papa is in his mid-seventies with a new diagnosis of Parkinson's and dementia. Papa don't walk so good, as evidenced by Mama's dislocated shoulder. He fell, she tried to catch him, and they ended up in a pile on the floor with Mama underneath. It's amazing neither of them broke a hip, but then, stupid people tend to bounce instead of shattering.

Papa is a max assist, three people, and stands well over six feet tall. I am short. I mean, *short*. As in I put everything on the bottom shelves of my kitchen cabinets because I can't reach the second shelf short. Which, as you might imagine, puts me at a small disadvantage, leverage-wise, when moving folks like Papa onto and off of a bedside commode.

So why did Mama stand so close to me as I was helping two other people move Papa? Why did I have to tell her twice to back off (nicely, of course), and then actually almost knock her down when Papa sagged? Why? Why don't these people listen to me? I do, after all, do this every day.

Or the nice man with the crazy family. "He's a hard stick. The last hospital, they had to have five people try to get an IV in. You might want to call somebody...older, you know? Like, are you able to do this? I mean, do you know how to start an IV?"

By which time I'd gotten a nice big peripheral line, one stick, in a place it wouldn't bother him or be painful. I do, after all, do this every day.

Or the nice woman with the crazy family. "She's got thrush on her tongue. She needs Nystatin. I mean, that thrush is nasty. Look at how it rubs off when you swab her tongue."

Thrush doesn't rub off. The patient is also on long-course Diflucan therapy for yeast in other places, so thrush is a remote possibility. I suggested to the patient that she actually *brush her teeth* (without mentioning that her breath could knock over a horse), thus decreasing the problem.

Did I mention that I do this on a daily basis?


The one bright spot in the crowd of psycho patients' families and obnoxious doctors was the guy who owns one of the best Italian restaurants around. His wife kindly brought me a sampling of food for dinner--three takeout boxes' worth--which I ate with relish for lunch the next day.