Well, gosh. That's kind of a drag.

This is Cinco de Mayo, right? So there are gonna be fireworks, right? Right.

I just heard a few fireworks go off. 

Then a few more. This was happening, by the way, just down the street.

Then I heard a noise like a spark had hit a box of fireworks and they'd all gone off within seconds of one another.

Now I'm hearing sirens.

Sucks to be you, dude. At least we've had enough rain lately that you won't catch the grass on fire. 

Wonder if whoever-it-was kept his hands intact.

A journey long and strange.

Seven hundred posts ago, I started blogging. That was April 25th of 2004. There was one post previous to that, but I think I deleted it, as it was the typical first post of the new blogger.

Just over five years and seven hundred posts. Wow.

In five years, I've become ACLS and stepdown qualified. I've learned how to level ventriculostomies and fix broken lumbar drains. I can tell when diabetes insipidus is coming and when a patient's just diuresing from surgery. I can handle a brain coming out of its confines into the open air, a patient with a fever of 104-plus, wounds that pop open, people that fall, seizures, heart attacks, and strokes. 

I've said goodbye to five classes of surgeons who've gone on to practicing independently, and I've said goodbye to at least that many colleagues who've died unexpectedly.

I've held people who were dying in my arms, sometimes in order to turn them and sometimes because they just needed comfort. 

I've been hit, kicked, cussed at, spit on, thrown up on, shit on, peed on, and generally frazzled by the needs of hundreds of people, a minority of whom were in full control of their faculties. 

I've argued with, cried with, drunk coffee with, and commiserated with doctors and other nurses. 

I've considered going back to waiting tables more than once. 

I've answered hundreds of emails from other nurses and nursing students. 

Once, as I put my hand on a dying patient's chest to say goodbye, I felt her heart stop.

Once, after a long, tricky surgery, I got the honor of letting a pregnant woman hear her fetus's heartbeat for the first time after she came out of anesthetic.

I have commuted more miles than I care to count and gone up three scrub sizes. I've made a lot of friends, some of whom were patients and some of whom weren't. I haven't made, I'm glad to say, too many enemies.

I've fallen out of love, in love, out of love, in love....my personal life has been like the drive thru at an In-N-Out Burger. 

I held one cat while she was dying and welcomed two more fur-suited terrorists into my house a few months later. I re-acquired a big shaggy loveable dog, the only thing I missed from my marriage. 

I bought a house, helped ChefBoy rebuild the bathroom, painted everything in different brilliant colors, and am getting ready to do the painting thing again. 

I've reviewed beers, mascaras, toothpaste, frozen pizza, and shoes. 

I've sprained my ankle once, had at least three bouts of stomach flu, two cases of flu-flu, and gone up on my dose of antidepressants. 

I've gotten off the Pill. 

I'm facing dating again at nearly forty.

Five years ago, after I'd been a nurse for not-quite-a-year, I still prayed every day that I wouldn't kill or injure anyone during my shift. I don't do that any more. Instead, I pray that somebody, at some point during my shift, will feel like I made a difference. Once in a while my prayer gets answered, when a patient tells me that I gave her hope, or made him feel better, or believed her when she said she hurt.

I have more wrinkles now, and more pounds. I'm cynical and twisted and bitter sometimes. Occasionally I give up hope for a few minutes. Very occasionally you might see me leaning my head against the cool marble facade of the lobby, praying that I can make it through the rest of my shift and still want to come back in the morning.

And I still love what I do. I said a couple of posts ago that I felt like a fish finally dropped into water, and that's true today. I opened a tiny bottle of very good champagne just now and am celebrating five years of loving what I do, both work-wise and blog-wise.

This blog would not have survived as long as it has, and I would not have survived as long as I have in this business, had it not been for people who read, emailed, commented, and sometimes ranted at me or corrected my mistakes. Thank you. I can't say any more than that: you guys are the reason I am still here.

BWAHA!!

Fuck passion.

Oh, for cryin' out loud.

Some well-meaning person told me yesterday, after I excoriated him for using a toothbrush on an incision, that I must have a real passion for my work.

No. I do not have a passion for my work. I have a commitment to it, and a love for it, and I felt like a fish finally in water for the first time in my finny life when I got to nursing school, but I do not. Have. A passion. For nursing. I have a deep, consuming dislike of people who scrub incision lines with toothbrushes, though.*

I certainly do not have a passion for people who use the word "passion" as a positive term.

"Passion" is like "artistic". People who are artistic tend not to show up for work on time. They tend to be a little ADD. They tend to freak out and need a certain level of excitement in their lives that normal people can't tolerate. In short, they're drama queens. "Passionate" people are the same way: try to live a normal life with one of 'em and you'll find yourself on the receiving end of invented crises and tearful midnight phone calls as they attempt to keep things off-balance enough to make themselves happy.

A patient's wife told me the other day, as I was tranferring him to the ICU with a raging case of bacterial meningitis, that he had ignored two cerebrospinal fluid leaks following surgery because, you know, he's an artist. He has a mind above such things, don't'cha know. He had apparently ignored the clear, yellowish fluid running out of his nose in favor of demolishing old car parts, or whatever the hell it is he does for art, until the headache and nuchal rigidity got to be so bad that he couldn't stand up. The pus leaking from his incision should've been the first clue, but oh, you know these artistic, passionate people--he felt he simply had to finish chopsawing that radiator to get his Vision out into the world.

My ex-husband told me, after he and my best friend had started screwing like rabbits, that he'd done it because he missed the Passion in our Relationship. Uh...dude. Passion, with a few exceptions, does not last for fifteen damn years. If you're lucky, you can build a good, strong, solid, deep-rooted something that outlasts passion and over-reaches it. You were not lucky. You were, in fact, a drama queen asshole, which is pretty much what I told him after I finished laughing. 

See? Passion bad. Workhorse good. Boredom positive. Excitement debatable. Butterflies early, good; butterflies late, a sign of needing to up your Xanax.

I am sick and tired of artists and passionate people. Give me a good, strong, not-too-brilliant workhorse of a surgeon any day rather than the passionate, artistic guy with a gift who tells patients to shut up when he's talking and is prone to fits of the sulks. Give me the uninspired, hardworking nurse who shows up on time, doesn't miss details, and gives a decent report rather than the one who feels drawn by some Higher Shiny Cosmic Power to the field. The ones who are so very drawn to this marvelous, wonderful, fulfilling thing are the same ones who either end up in management, fucking things up for the rest of us, or who go back to accounting or truck-driving or whatever it was that they could actually pay attention to and be good at.

Give me a nice, good, workhorse of a boyfriend, while you're at it. I don't care if he bradys down into the 50's when he's relaxed; it'd be a nice change from constant tachycardia. If he spends days silent, punctuated by the occasional grunt, so much the better. Keep your Jack Russell terriers and your people in search of something all-consuming; I want somebody dull and reliable and not prone to causing crises for the sake of excitement.

Which is why I love my dog. Max is passionate about one thing only: bully sticks. Even then, he won't bite my fingers taking one from me, or stay out in the yard with one when it's raining. He's my new benchmark for sensible behavior.

*And while I'm bitching, what is it with you people scrubbing your incision lines with a damn toothbrush? Doesn't common sense tell you that that is a bad idea of the first order? Don't you think about things before you do them? What posessed you to...oh, wait. I'm getting back into excoriation mode. Sorry.

Margaret vs. Pauline

Two patients, both with problems.

One is on Medicaid. She was hit a couple of years ago by a drunk driver in a big SUV; her youngest child died. The older two survived. She was paralyzed from the belly down. She has Brown-Sequard Syndrome, which means her touch sensitivity and her movement ability are both completely out of whack and she has constant pain, even from gentle stimulus. She had to come back for a revision after surgery to repair a bone-deep bedsore didn't work out well.

The other is a privately-insured patient with money to burn. After years of plastic surgery and expensive beauty treatments, she decided to get her lower back pain fixed with a lumbar laminectomy. She has an inch-long incision in her back, private duty nurses around the clock, a Dilaudid pain pump with a basal rate, and a husband who waits on her hand and foot.

Guess which patient was more willing to get out of bed this morning? Guess which one cried and moaned and complained about having to have physical therapy today? Guess which patient refused to walk in the hall, while the patient next door would've given her eyeteeth for the chance?

*** *** *** *** *** 

You're the one that I still miss

She has vascular dementia and doesn't remember that her husband died three years ago. Her kids kept reminding her of that until I told them to stop it, that making her go through that grief again and again was cruel and unhelpful. She still asks where John is, though.

*** *** *** *** ***

Can't give up actin' tough; it's all that I'm made of

One of the new nurses asked me tonight how I managed not to burst into tears every time something sad or pathetic happened. I replied, half-joking, that it's because I'm cynical and bitter. Looking back, that answer made more sense than I realized at the time.

It's not that certain things don't break my heart; they do. It's just that you learn a certain distance over time that allows you to keep working, to keep doing unpleasant things to pleasant people and not obsess about it later.

I used to obsess all the time. Occasionally I still do. Mostly, though, it's out of anger at a person's situation rather than from grief.

I told the chaplain once that nurses believe in God primarily so that they'll have somebody to blame. This is still true.

In which Head Nurse turns back into a nursing blog, at least temporarily....

I'm back at work. That means I'm too tired to blog at the moment, but trust me: big things are coming.

And it won't just be about siding, windows, doors, bedroom paint, my choice of Roman shades for the new windows, and deck building. It'll be sexy, exciting posts about OMG GONNA KILL US ALL HOLY SHIT WHADDA WE DO RUN RUN RUN AWAY SWINE FLU FROM MEXICO!!

More later. I promise. Meanwhile, keep washing your hands, and keep tuned to this channel. Here at HN we're more committed to the truth than, say, Lou Dobbs.

PS: Cover your nose when you sneeze.

Can we all please just take a deep breath through our masks?

As some of you might have gathered through careful perusal of this blog, I live in Texas. I live, in fact, not too terribly far from San Antonio, where several cases of THE MOST HORRIBLE PANDEMIC AWFUL ZOMG FLU EVER SEEN were discovered.

And yet, I am not locking myself in my house and refusing to go out. (Well, actually, I am, but that's for reasons totally unrelated to swine flu. It's more like that's my normal routine.) I am not panicking or avoiding large public spaces like the grocery store. I am not dousing myself in bleach or drinking whole pots of green tea. I am not stocking up on ammo or bottled water. I am, in short, while not sanguine, not freaking out.

How come?

Because epidemics *happen*. Once one gets started--and there's ample evidence that this particular flu bug has been moving around both Mexico and the U.S. all season, quietly infecting people--there's not a whole lot you can do besides quarantining the infected and washing your hands. Even before one gets started, there's not much you can do to stay away from viruses on a daily basis besides avoiding sick people and washing your hands.

Given that I can't exactly avoid sick people unless I want to move into a cardboard box, I'm washing my hands. I'm brushing up on the management of cytokine storm (for you non-medical types out there, that's an immune reaction that goes overboard and overloads your organs and kills you) and reviewing what I know about things like respiratory and droplet isolation. I'm gonna put an extra set of scrubs in the car today, since it's likely that at some point, if this dadratted bug continues to spread, I'll be killin' time at the hospital rather than at home.

I'm more worried about the level of ignorance in the general public about viral infections and the transmission of the flu than I am about the flu itself. I'm seeing comments on public message boards from people who want to stock up on antibiotics or just start taking Tamiflu as a preventive measure (neither will work). I'm seeing evidence that most people don't really understand the difference between viruses and bacteria and how their infections differ. I'm hearing talk from people here Deep In The Heart about moving off to Wisconsin and building a hideout.

If there's going to be fallout from this bug, it'll be because people are kinda dumb, not because they fall over dead.

Unless the Gubmint reports that this particular strain of swine flu turns people into zombies, I will continue simply to wash my hands and cover my mouth when I sneeze. I ask you all to please do the same. 

And maybe next time there's a scary epidemic, it can happen *during* the  Nationally Recognized Music Festival, so NRMF will get closed down and I can finally find some parking near the bar. That would be nice.

In Which Jo Explains Why She's All About The Teeth

Teeth, my friends, are a big deal. When they work properly and are relatively sound, they don't inspire much thought beyond whitening and straightening. When they're not sound, all sorts of nasty things can happen.

First of all, they can fall out. Let's take as read the nutritional problems and aesthetic considerations of having no teeth: I'm more interested in the second possibility: they can rot. That hurts. It looks bad, smells bad, keeps you from eating nice crunchy things like vegetables, keeps you from smiling as widely as you otherwise might. It can also leave you with what's known in the medical biz as a flaming clusterfuck of problems. To wit:

Let's say you're a sixteen-year-old girl who's had minimal access to medical care and no access to fluoridated water all your life. You come to me with a history of a heart valve replacement, complaining now of constant severe headaches and dizziness. What do these two things have in common?

Believe it or not, rotten teeth.

See, if you have really, *really* bad teeth, you're setting yourself up for bacterial infections that can lodge in your heart valves. If the infection in your heart gets bad enough, you'll end up having to have one or more valves replaced because they'll be so damaged that they won't work correctly. *That* means you'll have to be on warfarin, a blood thinner, for the rest of your life so that you don't get clots in the new valves that could travel to your brain and cause you to stroke.

The trouble is, if you don't have access to comprehensive medical care, the original problem (teeth) won't be taken care of. That'll lead to bacterial infections that travel to other places. One of those places might be one or more of the arteries that feed your brain. That, my friends, is known as a mycotic aneurysm, and it is no fun at all. 

Further, since you're already on blood thinners to take care of the clotting possibility, that aneurysm (which is nothing more than a stretched-out, thin spot in an artery) will probably leak blood now and then, damaging your brain.

Oh, and you're four months pregnant.

So let's review the bidding: no medical care, no dental care (to speak of), rotten teeth. Rotten teeth lead to an infection lodging in a heart valve that goes undiagnosed and untreated until the damage is so extensive that the valve has to be replaced. Blood thinners to reduce the risk of clotting from the new heart valve, but (again, poor medical care) the levels of drug in your bloodstream aren't monitored, so your blood gets too thin. Meanwhile, another infection has lodged in your brain and stretched out an artery, which then bleeds a bit now and then and makes you miserable. And warfarin and early pregnancy do not, in the least little bit, mix.

And you're sixteen.

I have never, in all the years I've been at Sunnydale General, seen as many consults on one patient as I saw on this one. We had dental, OB, cardiology, internal med, neurosurgery, neurology, pediatrics...and those were just the medical consults. Her chart was overflowing and she hadn't even been there a week.

The end result was this: we took her off warfarin and put her on a heparin drip. Later, when she was ready for surgery, we took her *off* the heparin and fixed her aneurysm. She miscarried her pregnancy and had to be followed carefully by OB so that she didn't bleed out. Mom and Dad and I sat down for a long, long talk about how on earth to get her teeth fixed and get her on some sort of contraceptive so this didn't happen again. I was gobsmacked by the difficulties they faced just getting her to the hospital in the first place.

I thank the gods who on my birth have smiled. If I lived like she does--and, not to put too fine a point on it, but it's in a house that isn't square and is about six hours away from the nearest clinic, where the weather reports are all in a language that was used as code in World War II--I would be dead by now.

She's lucky she's not. She's lucky one of her parents can read. She's lucky the U.S. Government, in its unending wisdom, decided that several million dollars spent fixing her various problems was a better investment than a couple hundred spent preventing them in the first place.

*sigh*

Fluoride, people. Regular dental visits. If you can afford 'em, do 'em. If you can't, well, you might be lucky enough to find a clinic or university nearby that can do basic care for cheap. If you find yourself flush, you might help a friend get a cleaning.

And floss.

What makes a tough day

Somebody younger than me with a projected survival time of three months (we can do better with glioblastoma; renal cell carcinoma is "not responsive to treatment" once it's spread).

Somebody my age with an aggressive, bizarre, rare form of multiple-sclerosis-like neuromuscular disorder that takes your sight first, then your speech, but leaves your motor skills intact.

Somebody older than me with a family that treats her like a leper because she has MRSA.

Deciding, once and for all, to hold my tongue.

Kitten Update

This is why Max is sleeping on the dining room floor rather than on his bed:

Because, really, who could go against this extreme gutulousness?

...and little brother is catching up:

Getting rid of dead wood

Or, In Which Head Nurse Turns Into A Remodeling Blog. Temporarily. Again.

The 75-foot-tall, 60-year-old maple in the back yard has been reduced to a very large pile of extremely massy logs. The lean-to that sat off the kitchen and blocked the view of the window, and which I hated with everything including my toenails, has been reduced to a very large pile of trash and siding.

A whole bunch of different guys came and invaded my back yard this morning. Half of 'em were your typical tree crew, with ropes and great big chainsaws and leather straps hither and yon and one very tough woman who was roping off with the rest of 'em. The other half were the cheerful, dreadlocked hippies from across the street, who'd agreed to take down the shed in exchange for all the wood from the maple and a small consideration. By ten they were all hard at work; by one-thirty the entire character of the back yard had changed.

Boy, is it gonna be hot in here come summer. I hadn't realized how much shade the tree was providing. That, combined with the fact that it held two different species of woodpecker and a group of bushtits (BUSHTIT! BUSHTIT! Hi, Mom!) and a whole colony of squirrels, made it hard to get rid of. When the one-armed tree guy showed up, though, and looked doubtfully at it before saying, "Ma'am, thar ain't no way we can make this here tree safe," I knew it had to come down. The next big storm would've sent it onto the house, probably killing me and possibly killing Max.

The cheerful hippies uncovered a nest of baby rats at one point. Mama sped away as soon as that part of the wall came down, so I lifted up the babies on a shovel (their eyes weren't even open yet) and put them down in a protected place. Mama had gotten them within about fifteen minutes. I'll deal with that later; I didn't have the heart to kill little baby *anythings* whose eyes weren't yet open and who crawled around squeaking pathetically.

I don't have the heart for much, lately. Chef Boy and I are dunzo after five years. The only respectful way to put it is that we had irreconcilable differences and leave it at that. Part of all the chopping down and clearing away the dead, dying, and rotted stuff is so that I can see my way clear to what I have to do with the house. I'm sure there's a juicy metaphor there, but right now I'm not going to examine it.

Anyway, the whole damn shebang of tree and shed was accomplished without too much blood loss and no maiming. Only one person stepped on a nail, and only one person ended up under a falling wall. Luckily, it was a very light, poorly constructed falling wall.

When the tree guys had topped the tree (which was the really dangerous part; past a certain point, it was so rotten they couldn't climb it and had to work overhead) there was, for about ten minutes, a huge solid mass of trunk standing in the yard. All the branches had been cut off, and I could see the shape of the trunk, how it had twisted with the prevailing winds for years, where the critters had built nests, all of its history right there. 

Then all of the tree crew and all of the hippies grabbed the end of a rope and held the top of the trunk steady as one person chainsawed through the bottom of the trunk. You'd think it would take forever to get a tree like that down, but it pulled down surprisingly easily. One big cut, and the whole thing was on the ground. Turns out the trunk was rotten clear through and it never showed.

I'm sure there's some juicy metaphor there, but right now I'm not going to examine that one either.

Product Reviews: Paired X Chromosomes Edition!

It's product review time again, kids! This one is more gender-specific than usual. Boys are welcome to read, but are unlikely to come away with any useful information.

Girly, Foofy Product Review Number One: 1000 Hours Eyelash and Brow Tint

Yeah, I tinted my eyelashes yesterday. Before anybody gets all het up about blindness and skin reactions and so on, let me say that I had no trouble at all with this stuff--no eye irritation, no skin irritation, no nothing. It didn't even stain my skin when I accidentally glopped it all over.

1000 Hours is an Australian product that you can get online. I bought it because I've got white-rabbit eyelashes; they're totally invisible unless I'm wearing tons of mascara. I've been considering dyeing my eyelashes now for a few years, but had been scared off by stories of people getting horrible corneal scarring from the dyes available in the States. After doing some research online and talking to various beauty mavens I know, I went ahead and dropped $25 on the 1000 Hours black/brown tint and tried it out.

The verdict? It rocks. My eyelashes are now visible, but not artificial-looking. The application was easy and fast, and there was no horrible dye smell. I'm keeping this one.

Girly, Foofy Product Review Number Two: Boden dresses

Whoever designs dresses for Boden really likes women. Like, really a lot. I have three dresses from there, and they're all different, and they're all bangin'.

The first is a clingy jersey number with a deep V-neck that gives me a waist. The second is a more structured cotton dress with a U-neck and a full skirt that doesn't make me look like a munchkin. The third, which I just purchased with an eye toward one-hundred degree, one-hundred percent humidity days, is a lightweight crinkle cotton thing with an empire waist that doesn't make me look pregnant.

The verdict? Spendy, but totally worth it. Plus, if these dresses hold up the way other stuff I've gotten from Boden does, I'll be wearing them for years. 

Girly, Foofy Product Review Number Three: OPI nail polish

I don't use anything else any more. I don't paint my fingernails--why bother, when they're short and being scrubbed constantly?--but I do paint my toenails in the spring and keep 'em done through the summer. After brief flirtations with Revlon and other, lesser brands, I'm sticking to OPI from here on out. The polish wears well, the color in the bottle is what you'll get on your nails, and it's easy to take off, no sanding required.

The verdict? Why use anything else? You can get bottles for cheap(er) at places like Sally or your local Drug Emporium.

Untitled.

If you want your things, they're on the front step.

I finally watched WALL-E.

And it was the damn CG cockroach that got me.

You know? As the ship is taking off, and Wall-E is on it, and the cockroach is yelling, "Come back!"

It got me.

Sheesh.

Cryin' over a damn CG cockroach. This has got to be 1) a new low in Head Nurse History, and 2) a sign I need a week off.

Do Not Want: The brain edition.

Yeah, yeah, I know. I'm a lazy blogger, posting videos from YouTube and graphics from National Geographic. Tra friggin' la; I have the day off.

Which leads, of course, to what I've been doing recently. 

Which is dealing with encephalomalacia. 

Not my own, thankfully; the brain softening of other people.

See, your brain isn't supposed to be soft. It's kinda firm and resillient (in vivo, that is), with its own lovely network of venous sinuses and arteries and linings and ventricles. It's a thing of beauty, whether you're watching it live through a dissecting scope in the OR or on video.

Except when it gets soft. Then it's not so beautiful. Worse, though, than the aesthetic considerations is what encephalomalacia does to a person. Basically, it takes a productive, happy, loving member of society and turns them into a nonresponsive, snoring shell of a person who's getting fed through a tube.

And sometimes we simply don't know what causes it. We can take biopsies galore, we can run every single test on blood and CSF and urine and what-have-you that the most specialized specialists can think up, we can scan and X-ray and poke and prod...and we still don't know why you've all of a sudden become a lump in the bed.

It's frustrating. More than that, it enrages me. Bad enough that somebody that I grew to know a little and like a lot is dying; why on earth can't we figure out why?

The last time this happened, the diagnosis came back primary leptomeningeal melanoma. That happened years and years ago, when I was first starting out in neuroscience. That particular diagnosis was obtained on autopsy. This one probably will be, too.

*sigh*

This, my friends, is the bad thing about nursing: seeing somebody you thought was getting better suddenly get worse and having no hope of an explanation in time to fix them. The only bright spot is that, since we're hip-deep in researchers, maybe the *next* person won't be so badly off. If we can catch whatever-it-is in time. If they have the same thing. If we can figure out what this is in the first place.

Because it's been a while since poutine was mentioned on this blog...

Whatchoo lookin' at?

Five by Five

It's been a while since I've done a meme, so here's one:

1. Five posts from the blog which I particularly like:

This is the coin

Dear Joey

A Chrissolstikah Story

Nursing Students: A Love Letter

The Nurse's Guide To Specialists

2. Five things of which I am proud:

a. That I work out three to four times a week and thus can lift heavy things

b. That I started the prerequisites for nursing school at 30, despite feeling quite old

c. That of all my colleagues at the hospital, I only really have problems personally with one

d. That my dog likes me

e. That I can get pretty much anything to grow--outside.

3. Five things I'm a bit ashamed of:

a. My temper

b. My foul mouth

c. That I'm a beer snob

d. That I have a terrible weakness for beauty products

e. That every present I wrap looks like a mentally-deficient orangutan went at it with a chop saw.

4. Five things you'll never find in my house:

a. Miracle Whip

b. Far-right periodicals

c. Coors Light

d. A non-dusty surface

e. Anything you can't touch, use, or sit on.

5. Five things you'll always find in my house:

a. Coffee

b. Toilet paper (I have a morbid fear of running out)

c. Brain drugs (ibid)

d. Lots of books

e. Dog and cat hair

What're yours?

Strange Surprise, Endless Science

One of the biggest parts of a nurse's job is education. You teach patients how to take care of themselves in the hospital and at home, you teach family members what to expect from a particular diagnosis, you teach doctors how to write orders for labs that have to be done just so.

One of the hardest parts of a nurse's job is education. You have to make sure that what you're saying is comprehensible and that you're not going too fast for somebody who's already overwhelmed and frightened. You have to be sure that the message is getting across; sometimes, just saying "Don't scrub your incision with a toothbrush" isn't as obvious as it sounds to you, because that person will then go home and scrub their incision with a hairbrush instead (true story). 

And one of the hardest things about educating people is that sometimes you come face-to-face with the maxim "A little learning is a dangerous thing". 

We all have horror stories about taking care of other nurses, or doctors, or people whose family members are nurses or doctors. The main reason those are horror stories is because people who know *something* about something automatically assume that they know more than they do about that thing. In other words, they try to apply what works for them in their own particular branch of medicine to the branch of medicine they're now dealing with. Sometimes it works. Mostly, it doesn't. It's kind of like trying to install plumbing in a new house when all you've done is fix kitchen sinks for twenty years.

So the education part of the nurse's job gets harder. Most of the time, you're starting with a blank slate in terms of teaching a patient. With people who are medical to start with, you have to correct misunderstandings and revise what they know already before you can get down to the basics. 

Nurses have a fun job when they're in this position. See, a doctor or other medical person who's not a nurse will get a totally different picture of what's going on with a patient than the nurse taking care of the patient will. Sometimes the difference is in the details; sometimes it's more overarching than that. Usually the conflict, if there is one, has to do with the nurse's care of the patient rather than, say, a difference of opinion with the doctors on the case. 

No, I'm not taking the catheter out. I understand your concerns about a UTI, and I share them, but right now my bigger concern is keeping accurate records of intake and output, because the person in the bed has a condition that causes trouble with their electrolytes. Yes, it is typical to use anticoagulants in addition to mechanical therapies to prevent DVTs, but in this case, anticoagulants could potentially cause harm, so we're going with mechanical therapies and frequent turning. Yes, I agree with you on the pulmonary toilet angle, and I'm going off right now to rewrite the respiratory therapy orders. 

It's hard to remember, when you're getting quizzed by the guy with the MD whose daughter is in the bed, that it's not about you. It's about the care that his daughter is getting, and you just happen to be the person in line for questions today. It's also hard not to simply say, "Look; you might know more about allergies/rheumatology/endocrinology/dermatology, but I know more about *nursing*" and leave it at that. It's hard to educate, explain, and clarify with someone who is just as frightened (or more so) and overwhelmed (ditto) than the average bear, yet still keeps jumping ahead of you or going off on tangents.

So what to do? Keep calm. Explain everything, and don't assume that because the person you're talking to is medically-inclined you can gloss over things or skip stuff. Respect their opinions. After all, this is a doctor/nurse/RT/PT/whatever you're talking to; there's a good chance that their knowledge of your patient combined with their knowledge of the sciences will show up things you've missed. Remember that they know more, so they're liable to be more aware of possible complications and Scary Stuff than a layperson. Be kind. It can't be easy to know what they know and be seeing what they see, especially when it's their Baby Daughter/Beloved Husband in the bed. Keep in mind that medical folks are people too and might sometimes forget to eat or sleep, or might just need to be sent home to relax for a while. 

And don't act too amused when they express surprise that you know so much about what's going on. 

Squeeee.