Lieutenant Lumpy: An Update.

Another year, another clean set of scans and a pristine checkup with Dr. Crane and his Irrepressibly Cheerful Staff. (They always seem happy to see me? I guess because I don't look like Frankenstein's Monster?)

Next year, because the lung nodule I have has not changed in six years, I can start getting annual chest x-rays rather than an annual chest CT, along with my usual head/neck/orbits MR. I'll have to get all that every year for the foreseeable future, because (as Dr. Crane said), "These stupid salivary gland tumors have a really long fuse." And they tend to recur in both the original spot and met to really weird places.

Still, I'm happy. I didn't have to have radiation, I'm functional with The Bug, and I've discovered (and am still discovering) benefits to having an obturator for a palate rather than factory equipment.

One of the most interesting side effects of having CANSUH has been my failing to give a shit about a number of things that used to be really important. I can't believe, for instance, that I worried so much about how I sounded and looked after surgery. I mean, it's understandable--the first obturator was barely better than my postsurgical mouth, and the second one, while an improvement, left a *lot* to be desired.

(If I had it to do over again, I'd go back and tell myself that 1) a year seems much longer than it actually is, and 2) to go ahead and buy a Therabite prior to surgery, rather than waiting however many weeks I waited.)

I also Don't Really Care any longer about what people think about things I might decide to do. For instance, the headliner in my car is coming down. I'm going to repair it with these little twisty screw pin things, then cover the heads of the pins with little glow-in-the-dark stars. This is a good idea. I like this idea. Other people think it's a weird idea.

And SBAR. SBAR is a communication technique developed by the Navy and figured out independently by a number of smart people in other fields, and works like this:

In oral communication, it's important to get to the gist of what you're dealing with, explain the background in a few words, give your opinion of the problem, and suggest a solution. It's what we do, by instinct, when we call doctors for (say) medication orders for nausea:

"I'm taking care of Ms. Smith in 918. She's post-angio day two and has had intractable nausea and vomiting for the last eight hours. I've given her Zofran and Tigan, but it hasn't helped. She's currently not making a lot of urine, but has no IV fluids. Can I start gentle rehydration at 75 an hour and give her a dose of Decadron?"

It works great for oral communication. It sucks for written communication.

Which is why the Powers That Be at Sunnydale have decided that the nurses will now write an SBAR summary of their shifts, every shift, and include it in the shift notes.

SBAR is meant to be a crisis communication, or give information in the case of rounding or reporting. It's not meant to sum up an entire shift. Trying to chivvy a summation of what you did into a shift into SBAR form is just. Fucking. Stupid. The suggestion from TPTB is that we focus on the problem that occupied "80% of the shift," but come on: most nurses, even those with only three patients, have multiple problems to solve that occupy about 20% of each shift per problem.

It's a bad use of a really good tool.

So I wrote my SBAR reports in limerick form this week.

Situation: Ms. S is not making much pee;
                We wonder just why that might be.
                We think that she's dry
                And the prime reason why
                Is that she's in need of IVs.

Background: She suffered a stroke yesterday
                      For which she received TPA.
                      She's had bad reactions
                      To some medications (approximate rhyme; sorry)
                      And so she is barfing today.

Assessment: Lethargic, unhappy, and sore
                     With pulse running 144,
                     And 80 systolic
                     Abdominal colic
                     And puddles of gark on the floor.

Recommendation: Hydration is our biggest worry
                             'Cause she's gotten dry in a hurry.
                             To prevent AKI,
                             We really should try
                             To top her up *fast*, Dr. Curry. [had to change the MD's name to                                        anonymize]

Next week, it'll be haiku. Nobody reads my damn notes anyhow, so I don't really care what anybody thinks of them.