Saturday, March 12, 2011

Answers to the Further FAQs....

1. Parathyroid and thyroid issues: I know absolutely smurfling nothing about that thing in your neck that runs your metabolism. I'm sorry. I know I should remember more than Circumoral Tingling Is Bad, but honestly? I haven't dealt with anything thyroid-related in years and years and am therefore highly underqualified to say more than Circumoral Tingling Is Bad.

2. Work shoes: Right now I'm wearing the same pair of MBTs I've had for omigawd has it been six years? with Birkenstock insoles. Basically anything with Birkenstock insoles is what I'll wear to work. My only requirements for work shoes are that they be sturdy, closed all the way around, and not made of plastic.

3. The best way to chill a beer quickly is to put it in ice and add water until the mixture is slushy. Leave it in its container, of course. The best way to chill a beer slowly is to put it on the bottom shelf of your fridge and leave it alone for several hours. Please do not ever pour beer over ice. Thank you.

4. Head positioning for various types of strokes:

For bleeding in the brain, you want the person's head *up*, so stuff that's not supposed to be in the brain, like free blood, can drain. A bed angled so the head is up at least 45 degrees will also help decrease intracranial pressure. This rule is, of course, subject to the usual caveats about exceptions and modifications and ventriculostomies and pressure-monitoring bolts.

For a stroke caused by a clot, you want the person's head *down*--no more than, say, 30 degrees or so above horizontal. This is because you want the area around the clot to stay well-perfused so that damage is minimized. If you have a patient whose embolic stroke has converted to a hemorrhagic stroke, as sometimes, happens, then you have a nice little juggling act between watching their neurological status and keeping their ICP stable on the monitor.

5. How the hell I got here in the first place:

I had planned, after nursing school, to get a job working general med-surg for a couple of years and then head back to school to become a nurse practitioner in women's health. I applied for the job at Sunnydale on a whim, never imagining that they'd actually hire me. They did. In fact, they offered me the job before I'd left the hospital after my interview.

Then I discovered that I really like brains. I like the things that they do when they're healthy, and I like the weird ways they behave when they're not. I like spines, too, and all the jacked-up stuff that can happen if you partially or completely transect them. I also like all the things that can go wrong with peripheral nerves, or demylenating disorders, or crazy-ass injuries to tiny bits of people's heads. I stuck around for more than a couple of years. Now that Sunnydale's got that portrait of me up in the attic, I think I'll be sticking around a little longer.

6. I get a lot of questions, not just in the comments, about dumbass coworkers and eyerolls. In answer to the emails and the comment questions, I have this to say: I'm lucky to work with only a couple of people who raise homocidal urges in me. Those people I avoid as much as possible; it's the only way to make it through the day. It helps that I'm not alone in my avoidance, as nobody else can stand those folks either.

If you're stuck working with somebody who drives you 'round the bend, it's important to remember something: You Are An Asshole, Too. You Make Mistakes, Too. You are sometimes that person that nobody can stand. It's important, then, to treat even nutso coworkers with respect and kindness when you can't avoid them completely. I'm not sayin' here that I'm perfect, that I've never yelled at anybody--but I am saying that I'm learning (slowly) from my fuckups.

I try to kill people with kindness, especially if I really dislike them. Then I come home and I blog. Perhaps, if your work situation is really awful, you should start a blog!

7. The story about the neuro attending was, sadly, true. I should mention here that ever since then we've gotten along famously. Apparently all he needed to behave decently was a little bite-back.

8. On woodchucks chucking wood, and a formula for determining amounts of wood chucked:

Obtain one woodchuck. Allow said woodchuck unlimited access to a given number of linear feet of wood for twenty-four hours. Measure, at the end of that time, the amount of wood chucked by one woodchuck. Extrapolate from that number the amount of wood chucked by a group of woodchucks, controlling for variables such as size of woodchuck and number of teeth per animal. Divide that result by the sine of the number of angels that can dance on the head of a pin, and you have your answer.

The *tough* question is the one posed by Calvin to Hobbes: "How many boards would a Mongol hoard if a Mongol horde got bored?"


Dr Dean said...

Add some salt to your ice slush and your beer will be even colder!

terri c said...

Love this. LOVE THIS. Especially "I am an asshole too." Because I am. Circumoral weirdness, transient, can be OK if one is having an asthma exacerbation and has slammed a couple hits of albuterol, ineffectively. In that case the circumoral weirdness means you're quite well alive, enough to notice that your mouth feels strange.

RehabRN said...

Yes, I totally agree on the bad coworkers. I started my blog to document my beginnings as a nurse, but boy, it's good (and cheap) therapy, too!

Yes, I know WAYY too much about beer, and I go for the put beer in cooler, add ice around all the bottles and top with more ice. Close said cooler for at least two hours, assuming it's not 95 degrees. After 2, crack one open and enjoy.

BTW I cannot drink beer in's either draft or bottle...nothing else. And I plan on popping open one of my lambics to celebrate the last of vacation.

Anonymous said...

Thank you for answering my silly shoe question! I'm procrastinating my nursing theory paper by reading your blog. Boo nursing theory.

Heidi said...


not very eloquent anon said...

Boo nursing theory! Dear nursing student, I was very recently where you are now, and as we used to say many, many times in nursing school, "Just poop it out." :)

Jo, I have another question from you from my endlessly curious neuroscientist roommate (seriously, he's like a 3-year-old with a PhD):

What I'm curious is whether exposing the surface of the brain to cold (e.g. if the skull/dura has been removed) will cause vasoconstriction (like the skin)
or vasodilation (to try and maintain temperature of a vital organ).

I don't know if you would know this. I don't know if anyone knows this. But he asked, and of all people I think you are the most likely to have an answer.

Jo said...

NVEA: I have no freaking clue. I'll ask at work, though, and see if anybody knows. It's an interesting question.

jamiegirl said...

I love that you had your plans and along the way you found out you really liked brains. I laugh at the people who ask me,"What area do you plan to specialize in for Nursing,? because I know damn well while I have my dreams everything can change along the way! It all depends on whom we meet, how it goes, and what we stumble upon.
Who knows, the fun is in the figuring it out along the way!

Anonymous said...

I swear the nursing theory course is the one class that 99% of all nursing students hate (there's always a few nuts in every bunch who like to read stuff like philosophy & junk). BUT in my 20 years in a hospital I swear that what they learn in the theory course comes up again and again.... On an interdisciplinary team, on nursing committees, in professional organizations, anytime planning for nursing services comes up. Its fascinating to me that such a hated course (there's no real point, no utility, whine, whine)makes such an impression on nurses who care about their practice.