For the first time in five years, I got recalled the other night. We'd had ten inches of rain in about four hours, atop already-saturated ground, and the hospital was short staffed. There were folks who simply couldn't make it to the building.
So the night supervisor started calling people from the day shift to see if they'd want to come in and work all night, then be off the next day. The recall, thankfully, was optional for people who'd already worked that day, as I had.
It had taken me an hour and a half to get home. The streets around the hospital were flooded. The major arteries in the city were flooded. They were pulling people out of their cars in high water near the party section of town. The frigging *highway* was flooded. As in, all the way home, a drive of about thirty-eight miles, I wondered if I would make it or end up flooded out like the countless cars I saw awash on the shoulder.
I did not go back in.
In other news, a patient I had cared for a couple of years ago walked in early last week to say hi. This was news because, the last time I saw her, she was going somewhere else for experimental treatment of some bizarre cancer I'd never heard of before and haven't seen since. After two years of chemo and radiation and removal and replacement of various bits of her spine, she's in remission and doing well.
The last time I saw her, I was loading her on to an ambulance stretcher from a Roto-Bed. (That's a bed that moves horizontally and vertically on its axis to keep a person who can't move from getting bedsores.) She was completely unable to move, barely able to breathe. The only thing alive about her were her eyes and her masses of gorgeous black hair.
The hair's gone, thanks to the treatment, but her eyes are the same. And she was able to hug me, tightly, when before she couldn't move her arms.
I don't normally cry at work. I *certainly* don't cry at work where other people can see me. I broke those rules when I recognized her.
Finally, I close on The House today. In about an hour and forty minutes. No, make that an hour and thirty-eight minutes. Thirty-seven. Not like I'm nervy about it, or anything. The entire process has been remarkably pain-free; I was expecting something like the soul-crushing, life-eating experience Chef Boy had in buying his first house.
The only screwup so far has been minor, and will result in me being a little late to my own closing. Like a bride who's late to her own funeral, I'm not concerned--I figure they can't start without me, so why worry?
This blog will be changing after I take posession of the house. I'll be so obsessed with wiring, insulation, paint colors, mortar, and wall tile that I'll have to abandon my usual set of metaphors and go to a new set--one that describes patients' conditions in terms of building materials.
Friday, June 29, 2007
Thursday, June 21, 2007
Thrashing
Just an FYI: Blogger is losing comments, or not publishing the ones I approve, and occasionally the blog just disappears. There's no bug bulletin up about these issues, but I'm not the only one with 'em.
So have patience. Perhaps your comments will show up; perhaps they won't. Everything except spam is getting approved, but some of the approved ones are getting lost in the ether (sorry, SHZ!). Maybe the blog will be here when you want to read it, maybe it won't.
Dratit.
So have patience. Perhaps your comments will show up; perhaps they won't. Everything except spam is getting approved, but some of the approved ones are getting lost in the ether (sorry, SHZ!). Maybe the blog will be here when you want to read it, maybe it won't.
Dratit.
Saturday, June 16, 2007
Oh, so *that's* why I was so tired.
It wasn't a cold. It was bronchitis. The bacterial sort, rather than the viral sort. The cold I had led to a bacterial superinfection that is now getting its butt kicked with Spectracef (note: Spectracef is one nasty drug).
I slept all day today. *All* day. As in, I got up at six to pee, drink a cup of coffee, and eat some toast, then went back to bed. Got up at one to do the same thing, then went back to bed. Got up at six-thirty this evening and am waiting on toast right now.
So if I'm not around much in the coming days, that's why. The good news is that I feel considerably better. The bad news is that now everybody else at work has this, too. *sigh*
I slept all day today. *All* day. As in, I got up at six to pee, drink a cup of coffee, and eat some toast, then went back to bed. Got up at one to do the same thing, then went back to bed. Got up at six-thirty this evening and am waiting on toast right now.
So if I'm not around much in the coming days, that's why. The good news is that I feel considerably better. The bad news is that now everybody else at work has this, too. *sigh*
Friday, June 15, 2007
Monday, June 11, 2007
Don't pick.
It all started with a zit.
It was a typical zit, close to his hairline. You know the sort: it grows and grows and gets painful, and finally you notice that it's got a head on it, so you pop it. The thing goes away for a while, but then it comes back. So you pop it again. Lather, rinse....
Six months later, it became obvious that something was wrong. There was that odd red mark where the zit had been, and he wasn't feeling well. Off he went to one doctor, then another, finally culminating with one of our gals for a CT and an MRI and a this and a that.
The various tests revealed various things: that his body was fighting off an infection, that he was losing his balance and having some trouble finding words, that he had been plagued by a constant headache for months. The scans showed an abscess just behind and above where the zit had been.
The abcess had eaten through his skull and into his brain. Lovely. You know it's bad when somebody's skull looks like Swiss cheese in one spot, with bits of dura poking out of the bone because of the pressure inside.
To the OR, then, and the bone comes out. The abcess gets drained. He's returned to the floor with powerful IV antibiotics...and then, quite suddenly, nothing seems to be working. Fever of 41 C (that's 106 F), heart rate in the 160's, big rash all over. We spring into action with cooling blankets, cultures of blood, sputum, and urine, chest X-rays, and fungal cultures of damn near everything else.
Further scans revealed that things had gotten nasty under his skull, so back he went for more draining and washouts. Right now he's in the unit with a tube going into his brain for further instillations of antibiotics and pressure reduction.
People, don't pick yer zits. I don't know how many times I have to say it.
Still, I guess it's better than that one gal who ended up with meningitis from brushing her teeth too enthusiastically.
It was a typical zit, close to his hairline. You know the sort: it grows and grows and gets painful, and finally you notice that it's got a head on it, so you pop it. The thing goes away for a while, but then it comes back. So you pop it again. Lather, rinse....
Six months later, it became obvious that something was wrong. There was that odd red mark where the zit had been, and he wasn't feeling well. Off he went to one doctor, then another, finally culminating with one of our gals for a CT and an MRI and a this and a that.
The various tests revealed various things: that his body was fighting off an infection, that he was losing his balance and having some trouble finding words, that he had been plagued by a constant headache for months. The scans showed an abscess just behind and above where the zit had been.
The abcess had eaten through his skull and into his brain. Lovely. You know it's bad when somebody's skull looks like Swiss cheese in one spot, with bits of dura poking out of the bone because of the pressure inside.
To the OR, then, and the bone comes out. The abcess gets drained. He's returned to the floor with powerful IV antibiotics...and then, quite suddenly, nothing seems to be working. Fever of 41 C (that's 106 F), heart rate in the 160's, big rash all over. We spring into action with cooling blankets, cultures of blood, sputum, and urine, chest X-rays, and fungal cultures of damn near everything else.
Further scans revealed that things had gotten nasty under his skull, so back he went for more draining and washouts. Right now he's in the unit with a tube going into his brain for further instillations of antibiotics and pressure reduction.
People, don't pick yer zits. I don't know how many times I have to say it.
Still, I guess it's better than that one gal who ended up with meningitis from brushing her teeth too enthusiastically.
Thursday, June 07, 2007
Rant. Rave.
Gracious, colds take a long time to get over. My two remaining brain cells are huddled in the back of my skull, wrapped in blankets, drinking tea. I'm no longer *quite* as snotty as I was, but goshdarn I'm tired.
Rants:
1. I do not wanna hear you apologizing for "bothering" a doctor when you page her. The correct phrase, when you answer the phone, is "thank you for returning my page." You are not bothering her. You are her eyes and ears and hands when she's not there, so it's reasonable for you to page her with changes or questions. Got it?
2. Lose the acrylic nails. For cryin' out loud, acrylic nails have been implicated in hinty-gazillion reports about the transmission of Nasty Bacteria. Thank you.
3. I should not (and I cannot believe I am saying this again) be able to see either your sacral tattoo or your thong string above your scrubs. Please.
4. Residents: Bathe. That is all.
5. Patients: If you refuse your insulin, refuse to stay on bedrest, refuse tests and procedures and lab draws, don't be shocked when we tell you there's not a lot we can do and send you home.
Raves: Ode To Underappreciated Things
1. Mucus. Who doesn't love mucus? I mean, really. It traps bacteria, viruses, pollen, and small animals; it keeps your stomach from digesting itself; it lubricates your intestines. Sure, sometimes there's too much of it, but on the whole, we don't give mucus the love it deserves. I'm going to start agitating for a National Mucus Appreciation Day.
2. Avril Lavigne: Sure, she's sold out. Yeah, the edgy rebel with the bad attitude got married in Chanel and bought a seven-million-dollar house, but come on. She's got a song out now with the line "She's like, so whatever" and Toni Basil-style handclaps. She's consciously moved from Avril Lavigne the Artist to Avril Lavigne the Parody, and I love her for that.
3. Ramen: Highly processed and full of fat, yes, but what better medicine for a cold do you know? (I don't like chicken soup.) Ramen is patient, ramen is kind to unhappy stomachs, ramen never fails. It, like Twinkies and TV Guide, will be able to survive a nuclear holocaust with no problem. Plus, it never goes stale, even if the package has a hole in it.
4. Vietnamese instant coffee: when you just can't stomach the regular stuff, this magical powder will not only settle your insides but provide you with a buzz that would shame a beehive. Plus, it leaves a weird residue on the inside of your cup, and I think it's full of trans fats. Perfect with ramen.
5. Cheesy fashion magazines. Constantly pilloried for promoting an unhealthily thin body type and conspicuous consumption, fashion magazines are actually the opiate of the cold-infected. Two hours of Vogue or Elle will put your brain into such a comfortable alpha-wave state that it'll feel like you've slept for a week.
Thus endeth the rant/rave for this week. I'm off to get more ramen.
Rants:
1. I do not wanna hear you apologizing for "bothering" a doctor when you page her. The correct phrase, when you answer the phone, is "thank you for returning my page." You are not bothering her. You are her eyes and ears and hands when she's not there, so it's reasonable for you to page her with changes or questions. Got it?
2. Lose the acrylic nails. For cryin' out loud, acrylic nails have been implicated in hinty-gazillion reports about the transmission of Nasty Bacteria. Thank you.
3. I should not (and I cannot believe I am saying this again) be able to see either your sacral tattoo or your thong string above your scrubs. Please.
4. Residents: Bathe. That is all.
5. Patients: If you refuse your insulin, refuse to stay on bedrest, refuse tests and procedures and lab draws, don't be shocked when we tell you there's not a lot we can do and send you home.
Raves: Ode To Underappreciated Things
1. Mucus. Who doesn't love mucus? I mean, really. It traps bacteria, viruses, pollen, and small animals; it keeps your stomach from digesting itself; it lubricates your intestines. Sure, sometimes there's too much of it, but on the whole, we don't give mucus the love it deserves. I'm going to start agitating for a National Mucus Appreciation Day.
2. Avril Lavigne: Sure, she's sold out. Yeah, the edgy rebel with the bad attitude got married in Chanel and bought a seven-million-dollar house, but come on. She's got a song out now with the line "She's like, so whatever" and Toni Basil-style handclaps. She's consciously moved from Avril Lavigne the Artist to Avril Lavigne the Parody, and I love her for that.
3. Ramen: Highly processed and full of fat, yes, but what better medicine for a cold do you know? (I don't like chicken soup.) Ramen is patient, ramen is kind to unhappy stomachs, ramen never fails. It, like Twinkies and TV Guide, will be able to survive a nuclear holocaust with no problem. Plus, it never goes stale, even if the package has a hole in it.
4. Vietnamese instant coffee: when you just can't stomach the regular stuff, this magical powder will not only settle your insides but provide you with a buzz that would shame a beehive. Plus, it leaves a weird residue on the inside of your cup, and I think it's full of trans fats. Perfect with ramen.
5. Cheesy fashion magazines. Constantly pilloried for promoting an unhealthily thin body type and conspicuous consumption, fashion magazines are actually the opiate of the cold-infected. Two hours of Vogue or Elle will put your brain into such a comfortable alpha-wave state that it'll feel like you've slept for a week.
Thus endeth the rant/rave for this week. I'm off to get more ramen.
Sunday, June 03, 2007
Doped to the gills on Sudafed and wine.
I am coming down with another bedamned cold. My right ear has been clogged for three weeks now; Sudafed offers temporary relief. Today, when the 70-mph winds blew in with their four inches of rain, my chest started hurting. Now I'm grumphing and blowing like an old man with emphysema.
But I made an offer on a house. And it has been accepted. Verbally only, so hold your applause. Keep your digits crossed that the contract gets signed, the inspection reveals no past craziness with termites, and that I can afford to RamJack the house up level. Provided all that happens, my 1948 end-of-year Sunbeam mixer will finally have a kitchen that matches it.
Living with expansive clay soils means that everything, from a 1200-square foot Home For Heroes to the Capitol building, shifts. Sometimes there's subsidence; sometimes the whole damn thing slides down a hill. Luckily for me and my bank account, the subsidence is more of a problem than sliding downhill, since the land is flat.
Living with enormous thunderstorms means you need storm windows, which this house does not have. Likewise, you need gutters, ditto. Likewise, you need a cistern, especially if you intend to keep the St. Augustine grass in the yard, which requires a weekly dose of an inch of water, more in 100 degree heat.
Living with a pecan tree (the state nut, did you know?) in the back yard means that every time a 70-mph wind blows through town, you fret and agonize over the possibility of pecan limbs landing on Your New House's roof. The first rule of camping in Texas is this: Don't lay your bedroll under a pee-can tree; them's the trees that drop branches fer no reason. Bigguns.
Of course, living with pecan trees and healthy shrubs and plenty of rain (this year, at least) means that when you open the lid to the breaker box, the real estate agent you've hired will stumble backwards with a choked scream as a six-inch-long pink gecko leaves its hiding place. And that a large toad will SCREEE at you when you almost step on it, backwards from the house steps.
The basics: It's a post-WWII (Dad is saying "Dubya dubya eye-eye" in his head) Home for Heroes with two bedrooms and a small bathroom that needs work. It's about 1200 square feet, give or take, sitting on a quarter acre. That's big enough for two large dogs who get along well. Or five greyhounds off the track. The original windows, six-over-six with wood dividers between the glass panes, are still there, as are the original fluted glass doorknobs. The kitchen has a built-in hutch with glass doors, perfect for storing Fiestaware (Beloved Sis is foaming at the mouth just now).
There's a room for working out. There's space for washer and dryer connections. The yard, despite something like seven feet of rain in the last three weeks, is not soggy. The foundation, while sagging, seems sound. The roof is halfway through its expected life. The floors are gorgeous. The cabinetry is all original, the doors all solid-core.
The neighborhood is neither scary nor train-track infested. There is a space just to the right of the front door for a rose bush grown from a clipping from Mom's bush up in Seattle, which originated at The Old House. That variety of rose is one nobody's ever been able to identify.
It's like having a brand-new boyfriend: I can't stop thinking about it, hoping it doesn't come to harm with the storms, wondering when I can see it again.
Dog won. Lack of maintenance lost. If you're ever in central Texas, look for the frazzled woman pushing a Green Mountain reel mower. That'll be me.
But I made an offer on a house. And it has been accepted. Verbally only, so hold your applause. Keep your digits crossed that the contract gets signed, the inspection reveals no past craziness with termites, and that I can afford to RamJack the house up level. Provided all that happens, my 1948 end-of-year Sunbeam mixer will finally have a kitchen that matches it.
Living with expansive clay soils means that everything, from a 1200-square foot Home For Heroes to the Capitol building, shifts. Sometimes there's subsidence; sometimes the whole damn thing slides down a hill. Luckily for me and my bank account, the subsidence is more of a problem than sliding downhill, since the land is flat.
Living with enormous thunderstorms means you need storm windows, which this house does not have. Likewise, you need gutters, ditto. Likewise, you need a cistern, especially if you intend to keep the St. Augustine grass in the yard, which requires a weekly dose of an inch of water, more in 100 degree heat.
Living with a pecan tree (the state nut, did you know?) in the back yard means that every time a 70-mph wind blows through town, you fret and agonize over the possibility of pecan limbs landing on Your New House's roof. The first rule of camping in Texas is this: Don't lay your bedroll under a pee-can tree; them's the trees that drop branches fer no reason. Bigguns.
Of course, living with pecan trees and healthy shrubs and plenty of rain (this year, at least) means that when you open the lid to the breaker box, the real estate agent you've hired will stumble backwards with a choked scream as a six-inch-long pink gecko leaves its hiding place. And that a large toad will SCREEE at you when you almost step on it, backwards from the house steps.
The basics: It's a post-WWII (Dad is saying "Dubya dubya eye-eye" in his head) Home for Heroes with two bedrooms and a small bathroom that needs work. It's about 1200 square feet, give or take, sitting on a quarter acre. That's big enough for two large dogs who get along well. Or five greyhounds off the track. The original windows, six-over-six with wood dividers between the glass panes, are still there, as are the original fluted glass doorknobs. The kitchen has a built-in hutch with glass doors, perfect for storing Fiestaware (Beloved Sis is foaming at the mouth just now).
There's a room for working out. There's space for washer and dryer connections. The yard, despite something like seven feet of rain in the last three weeks, is not soggy. The foundation, while sagging, seems sound. The roof is halfway through its expected life. The floors are gorgeous. The cabinetry is all original, the doors all solid-core.
The neighborhood is neither scary nor train-track infested. There is a space just to the right of the front door for a rose bush grown from a clipping from Mom's bush up in Seattle, which originated at The Old House. That variety of rose is one nobody's ever been able to identify.
It's like having a brand-new boyfriend: I can't stop thinking about it, hoping it doesn't come to harm with the storms, wondering when I can see it again.
Dog won. Lack of maintenance lost. If you're ever in central Texas, look for the frazzled woman pushing a Green Mountain reel mower. That'll be me.
Tuesday, May 29, 2007
Freddy Mercury: Still Dead.
This has been one of those weeks in which you could look at the glass half-full or half-empty. Or half-empty or half-empty, unless it was filled with a good single-malt, in which case it'd be gone before you could tell.
Bad: La Schwankienne is cutting staff, cutting beds, but not cutting the number of surgeries its surgeons perform. This has led to understaffing and stressful bed crunches.
Good: La Schwankienne Hospital has announced its new program: Facilitating Patient Independence. Cardiac patients will now be taught to monitor their own rhythms, since there are no more monitor supervisors to do so. Orthopedic patients will perform their own physical therapy with the help of colorful instructional materials, since there aren't enough physical therapists. And patients with brain injuries will learn self-sufficiency by administering their own medications in the proper doses at the proper times, as there are no longer enough nurses. Those patients who are well enough to take care of other patients will receive an additional loaf of brown bread and an extra measure of gin with dinner.
Bad: I've tried to get in to two houses in the last two days, only to find that purchase contracts were signed on them Friday afternoon and this morning, respectively.
Good: My interest spells good luck for someone else.
Bad: We've had flooding here recently.
Good: It gives me an excuse other than seasonal writer's block for not blogging, as it's difficult to write with a snorkle on. Additionally, the rising waters are driving away the obnoxious Californians who moved in to the area five years ago and pushed real estate prices to an amazing level.
Bad: Holy Kamole, our sister hospital, had a nasty power surge that cut off the oxygen generators for an afternoon.
Good: We got to get rid of all those silly oxygen cylinders that were cluttering up the hallway. And some of those silly patients as well, as there won't be oxygen enough to get them down to the ICU if they code.
Bad: It just started to rain again.
Good: West Nile Virus-carrying mosquitoes are practically nonexistent this season, as they like to breed in stagnant water. There's been so much rain that they, like the Californians, have fled to less-turbulent climes.
Bad: Freddy Mercury is still dead.
Good: Someone, somewhere, is building a time machine that will allow me to go back to 1975 and warn him about GRID or HLTV-II before it becomes AIDS.
I can dream, can't I?
Bad: La Schwankienne is cutting staff, cutting beds, but not cutting the number of surgeries its surgeons perform. This has led to understaffing and stressful bed crunches.
Good: La Schwankienne Hospital has announced its new program: Facilitating Patient Independence. Cardiac patients will now be taught to monitor their own rhythms, since there are no more monitor supervisors to do so. Orthopedic patients will perform their own physical therapy with the help of colorful instructional materials, since there aren't enough physical therapists. And patients with brain injuries will learn self-sufficiency by administering their own medications in the proper doses at the proper times, as there are no longer enough nurses. Those patients who are well enough to take care of other patients will receive an additional loaf of brown bread and an extra measure of gin with dinner.
Bad: I've tried to get in to two houses in the last two days, only to find that purchase contracts were signed on them Friday afternoon and this morning, respectively.
Good: My interest spells good luck for someone else.
Bad: We've had flooding here recently.
Good: It gives me an excuse other than seasonal writer's block for not blogging, as it's difficult to write with a snorkle on. Additionally, the rising waters are driving away the obnoxious Californians who moved in to the area five years ago and pushed real estate prices to an amazing level.
Bad: Holy Kamole, our sister hospital, had a nasty power surge that cut off the oxygen generators for an afternoon.
Good: We got to get rid of all those silly oxygen cylinders that were cluttering up the hallway. And some of those silly patients as well, as there won't be oxygen enough to get them down to the ICU if they code.
Bad: It just started to rain again.
Good: West Nile Virus-carrying mosquitoes are practically nonexistent this season, as they like to breed in stagnant water. There's been so much rain that they, like the Californians, have fled to less-turbulent climes.
Bad: Freddy Mercury is still dead.
Good: Someone, somewhere, is building a time machine that will allow me to go back to 1975 and warn him about GRID or HLTV-II before it becomes AIDS.
I can dream, can't I?
Monday, May 21, 2007
I can't decide...I can't decide....
So I have to move this summer.
I have a choice: house or apartment?
House comes with the possibility of a big, happy dog, like a Cane Corso or a lurcher or a big ol' Anatolian (my favorite breed, next to Greyhounds, which of course I'd have one of as well) and a place to plant herbs.
Apartment comes with less responsibility, free weight room, pool, somebody else to do the maintenance. But I can't paint, I can't plant herbs, and I certainly couldn't have a Molosser.
House I could do things to. Apartment I wouldn't have to.
House I could play around with. Apartment I couldn't...but there'd be somebody there to fix the faucets.
*sigh*
The thing that's swaying me is the dog issue. It's been *so* long since I had a dog.
Must...decide...by...July...first....argh.
I have a choice: house or apartment?
House comes with the possibility of a big, happy dog, like a Cane Corso or a lurcher or a big ol' Anatolian (my favorite breed, next to Greyhounds, which of course I'd have one of as well) and a place to plant herbs.
Apartment comes with less responsibility, free weight room, pool, somebody else to do the maintenance. But I can't paint, I can't plant herbs, and I certainly couldn't have a Molosser.
House I could do things to. Apartment I wouldn't have to.
House I could play around with. Apartment I couldn't...but there'd be somebody there to fix the faucets.
*sigh*
The thing that's swaying me is the dog issue. It's been *so* long since I had a dog.
Must...decide...by...July...first....argh.
Saturday, May 19, 2007
Things that make the needle on the Baffleometer swing to the red, part 386
Why is it that the neurology residents, after ordering twelve tubes of blood drawn on one patient (yes, literally twelve tubes) for various obscure tests, return to the floor or call with a telephone order for one more test? And why is it always the test that can't be run from any of the tubes already drawn?
Why do tacos come in threes? Twinkies come in pairs. So did Noah's animals. So do senators. Are tacos like celebrity deaths and plane crashes? And if so, should I be eating them?
Why on earth is that resident wearing both bi-colored wingtip shoes *and* a bow tie?
Why do people think tan looks better?
Why did Louis Farrakhan record "Zombie Jamboree" as a young man? Did he really think it would be his ticket to fame? (Speaking of bow ties.)
Why do our urologists have such huge fucking egos? Would it kill them to be polite once in a while?
Why isn't there a decent Ethiopian restaurant in this town?
Why do tacos come in threes? Twinkies come in pairs. So did Noah's animals. So do senators. Are tacos like celebrity deaths and plane crashes? And if so, should I be eating them?
Why on earth is that resident wearing both bi-colored wingtip shoes *and* a bow tie?
Why do people think tan looks better?
Why did Louis Farrakhan record "Zombie Jamboree" as a young man? Did he really think it would be his ticket to fame? (Speaking of bow ties.)
Why do our urologists have such huge fucking egos? Would it kill them to be polite once in a while?
Why isn't there a decent Ethiopian restaurant in this town?
Thursday, May 17, 2007
Sunday, May 13, 2007
Product Reviews: Mother's Day Edition
It's time again for non-professional product reviews. If you schlubs want me to review your book or your product or your salted pistachios, you gotta email me. Until that time, I review what I got.
Cutting Remarks: Insights and Recollections of a Surgeon, by Sidney M. Schwab, MD.
Sid is known to most of us as Dr. Sid, the proprietor and author of Surgeonsblog. Here he collects stories and cautionary tales from his training as a general surgeon (1970-76, UCSF). I have three words for you:
Buy this book.
More accessible than Oliver Sacks, funnier by far than Atul Gawande, totally devoid of snarky ego, and a fascinating insight into how surgeons are made and how they evolve. Buy this book. Read it. If you work with surgeons, read it again. Stick little bits of torn-up paper in between the pages you find particularly interesting, as I did. Keep it by the bedside.
I once reviewed a book here and had hellish trouble finding anything nice to say about it. I am now having hellish trouble not fawning over Cutting Remarks. Sid neither suggested I review this book, nor did he send me boxes full of cheese curds and poutine gravy. I'm doing it on my own.
Verdict: Buy the damned book already. If we're lucky, he'll write another one.
Everybody's Nuts Roasted and Salted Pistachios
The back of every Everybody's Nuts box contains a vignette about pistachios. They are less interesting than the nuts themselves. The nuts are big, as advertised; open, as advertised; crunchy and salty and easy to eat. I have a bag of them next to me right now.
Verdict: Recommended.
Land's End Women's Sleeveless Super-T
Extremely soft. The sleeve-less-es are wide enough that your bra straps don't hang out, and the neck is low enough that you avoid the Enormo Neck Problem (especially if you're me and have more trapezoids than neck). No show-through, even with the white ones. I'm five-foot-two, a size 12/14, and the large fits perfectly. It falls to the bottom of my butt while covering the sides of my bra at the arm holes.
Verdict: Why get anything else? Volume discounts so you can show off your guns in different brilliant colors.
How To Cook A Wolf, M.F.K. Fisher
This is the cookbook Fisher wrote (and later revised) for World War II shortages and rationing. You won't want to attempt most of the recipes here, but she does have excellent advice on how to deal when you got no money, no cheese, no butter.
Her best advice? Carry a (filled) flask with you at all times in case the air-raid sirens go off. That way you'll be set for several hours if you end up in a dark basement with strangers. I would follow this advice daily, since I deal with the dark-basement-and-strangers thing routinely, but I'd get fired.
Verdict: A good read, but optional.
Mirena intrauterine contraceptive
Not A Cramp In A Carload!
I had this bad boy installed on Wednesday. I won't lie: the insertion hurt like a sonofabitch, because I haven't had kids. I have not, however, had any trouble since. Days 1 and 2 I took ibuprofen to control the cramps and have not taken any since then.
It's good for five years and is for both multiparous and nulliparous women. It does *not* protect against STDs and can, in fact, raise the chances of a woman getting PID if she has multiple partners. The Mirena releases hormones that thin the uterine lining, making it a good choice for women who have heavy periods or lots of cramps.
My Mom
The best in the bunch. If you haven't had the opportunity to hang out with My Mom, you're missing out. My Mom is the finest-quality Mom available on the market currently; she uses less electricity than other Moms to accomplish the same tasks. She can also be left by herself for long periods in used bookstores without adverse consequences. My Mom should not be submersed in water for long periods of time. Hand wash with mild soap and hang to dry.
Verdict: You who don't have My Mom are big ol' losers.
Happy Mother's Day, Mom!
Cutting Remarks: Insights and Recollections of a Surgeon, by Sidney M. Schwab, MD.
Sid is known to most of us as Dr. Sid, the proprietor and author of Surgeonsblog. Here he collects stories and cautionary tales from his training as a general surgeon (1970-76, UCSF). I have three words for you:
Buy this book.
More accessible than Oliver Sacks, funnier by far than Atul Gawande, totally devoid of snarky ego, and a fascinating insight into how surgeons are made and how they evolve. Buy this book. Read it. If you work with surgeons, read it again. Stick little bits of torn-up paper in between the pages you find particularly interesting, as I did. Keep it by the bedside.
I once reviewed a book here and had hellish trouble finding anything nice to say about it. I am now having hellish trouble not fawning over Cutting Remarks. Sid neither suggested I review this book, nor did he send me boxes full of cheese curds and poutine gravy. I'm doing it on my own.
Verdict: Buy the damned book already. If we're lucky, he'll write another one.
Everybody's Nuts Roasted and Salted Pistachios
The back of every Everybody's Nuts box contains a vignette about pistachios. They are less interesting than the nuts themselves. The nuts are big, as advertised; open, as advertised; crunchy and salty and easy to eat. I have a bag of them next to me right now.
Verdict: Recommended.
Land's End Women's Sleeveless Super-T
Extremely soft. The sleeve-less-es are wide enough that your bra straps don't hang out, and the neck is low enough that you avoid the Enormo Neck Problem (especially if you're me and have more trapezoids than neck). No show-through, even with the white ones. I'm five-foot-two, a size 12/14, and the large fits perfectly. It falls to the bottom of my butt while covering the sides of my bra at the arm holes.
Verdict: Why get anything else? Volume discounts so you can show off your guns in different brilliant colors.
How To Cook A Wolf, M.F.K. Fisher
This is the cookbook Fisher wrote (and later revised) for World War II shortages and rationing. You won't want to attempt most of the recipes here, but she does have excellent advice on how to deal when you got no money, no cheese, no butter.
Her best advice? Carry a (filled) flask with you at all times in case the air-raid sirens go off. That way you'll be set for several hours if you end up in a dark basement with strangers. I would follow this advice daily, since I deal with the dark-basement-and-strangers thing routinely, but I'd get fired.
Verdict: A good read, but optional.
Mirena intrauterine contraceptive
Not A Cramp In A Carload!
I had this bad boy installed on Wednesday. I won't lie: the insertion hurt like a sonofabitch, because I haven't had kids. I have not, however, had any trouble since. Days 1 and 2 I took ibuprofen to control the cramps and have not taken any since then.
It's good for five years and is for both multiparous and nulliparous women. It does *not* protect against STDs and can, in fact, raise the chances of a woman getting PID if she has multiple partners. The Mirena releases hormones that thin the uterine lining, making it a good choice for women who have heavy periods or lots of cramps.
My Mom
The best in the bunch. If you haven't had the opportunity to hang out with My Mom, you're missing out. My Mom is the finest-quality Mom available on the market currently; she uses less electricity than other Moms to accomplish the same tasks. She can also be left by herself for long periods in used bookstores without adverse consequences. My Mom should not be submersed in water for long periods of time. Hand wash with mild soap and hang to dry.
Verdict: You who don't have My Mom are big ol' losers.
Happy Mother's Day, Mom!
Saturday, May 12, 2007
Things Jo Hates Today. And Loves. And Can Tolerate.
Jo hates it when a kit she puts together for a lumbar drain just...disappears, five minutes before the drain is due to be put in.
Jo hates it when the day is so confused and chaotic that she forgets to hang an antibiotic until 1800, at which time the patient has been discharged for six hours.
Jo hates it when all the cafeteria has for lunch is pulled pork sandwiches and chicken adobo.
Jo hates failed procedures.
Jo loves it when she's passed all her medications and opened all her charts by nine a.m.
Jo loves chicken salad with pecans and red grapes.
Jo loves it when a patient tells her, "Thank you for answering all my questions. I was scared before, but I feel better now."
Jo loves it when she can peg a neurology resident from twenty feet away with a thrown ball of paper.
Jo can tolerate delays in MRIs getting read, but she's not happy about it.
Jo can tolerate a twisted sock for almost twelve hours.
Jo can tolerate a two-mile run.
Jo can tolerate it when people just...disappear, sort of like that lumbar drain kit, be it through death or dismissal or Personal Journeying, but that doesn't mean she likes it.
*** *** *** *** ***
I have ended up on somebody else's blog. Not *me* me, but my Mild-Mannered Alter Ego. One of my patient's fathers started a blog to document her brain surgery and had me pose with her for a few pictures. Those pictures are now up (or so they tell me) on the blog, with appropriate captions ("We don't know which ward this one escaped from, but she doesn't seem dangerous").
I just hope the Nurse Jo Cape didn't make telltale wrinkles under my scrub jacket.
Jo hates it when the day is so confused and chaotic that she forgets to hang an antibiotic until 1800, at which time the patient has been discharged for six hours.
Jo hates it when all the cafeteria has for lunch is pulled pork sandwiches and chicken adobo.
Jo hates failed procedures.
Jo loves it when she's passed all her medications and opened all her charts by nine a.m.
Jo loves chicken salad with pecans and red grapes.
Jo loves it when a patient tells her, "Thank you for answering all my questions. I was scared before, but I feel better now."
Jo loves it when she can peg a neurology resident from twenty feet away with a thrown ball of paper.
Jo can tolerate delays in MRIs getting read, but she's not happy about it.
Jo can tolerate a twisted sock for almost twelve hours.
Jo can tolerate a two-mile run.
Jo can tolerate it when people just...disappear, sort of like that lumbar drain kit, be it through death or dismissal or Personal Journeying, but that doesn't mean she likes it.
*** *** *** *** ***
I have ended up on somebody else's blog. Not *me* me, but my Mild-Mannered Alter Ego. One of my patient's fathers started a blog to document her brain surgery and had me pose with her for a few pictures. Those pictures are now up (or so they tell me) on the blog, with appropriate captions ("We don't know which ward this one escaped from, but she doesn't seem dangerous").
I just hope the Nurse Jo Cape didn't make telltale wrinkles under my scrub jacket.
Thursday, May 03, 2007
CoS/Gracious, I'm tired.
Change of shift is up here. I'm an asshole and missed it last week. Sorry, Kim.
Goodness. I'm tired.
Something about hundred-mile-an-hour wind gusts and bits of the hospital flying off and having to drive through four-inch-an-hour rain will really take it out of a girl. (We're all fine, by the way.)
Something about medical service patients who are, in a word, all batshit crazy will take it out of a girl.
And there's something about learning entirely new protocols and care plans and how to take care of totally unfamilliar patients that will take it out of a girl, too. This week it's been urology patients; the specialty has moved to our unit to partner with neurology. And if you think that causes problems when we page people, because of the sound-alike qualities of "urology" and "neurology", you'd be right. We've started referring to them as "brains" and "bladders" to make things easier.
Guys who've had their prostates out will talk about *anything*. One gentleman compared his prostate exam to labor and childbirth. I did not laugh. Another regaled me with tales of where one finds blood after a prostate biopsy. I did not run out of the room screaming.
(And that crazy patient? The one I said no to? Was fired by her surgeon shortly thereafter. Sweet, sweet justification of my actions. Sweet.)
Don't get me wrong: I'm not complaining. I'm liking having to learn new things on the fly, and there's a lot of interesting stuff coming in with the medicine and surgery folks. Like Whipple procedures--I'd not heard of that since nursing school. I'm doing a lot of research between patient rounds and boning up on drugs I'm not familliar with. But it's exhausting.
How exhausting? It's 15:45 and I just got out of bed. Cancelled my workout with the trainer today, skipped eating, and slept. This is how tired I am: a box from Sephora arrived and I didn't open it right away. I laid back down on the couch and dozed off instead.
General surgery patients are heavy, primarily because they're not routine for me. Neurosurgery and neurology I could do in my sleep because, well, that's all I've done for nearly five years now. But surgery and medicine have all these new orders and care tracks and protocols and I'm just blown. Plus, they tend to get better faster, so instead of six high-acuity admissions in a day, we have seventeen low-acuity admissions and just as many discharges in the twelve hours.
Overall, though, it's fun. The surgery guys have great senses of humor and are good to work with: intelligent, humane, and good at returning pages. The urology guys are just as all-around good, plus they have a stable of nurses who are helping us out as we get comfortable with their patients.
I just wish I could take a nap in the middle of the shift. After a day when I start with five patients (usually one or two high-acuity neurosurgeries in there), discharge three, get three, discharge two of those, get two more, and pick up one last one at 1815, I'm *so* done.
I wonder what's in that box from Sephora.
Goodness. I'm tired.
Something about hundred-mile-an-hour wind gusts and bits of the hospital flying off and having to drive through four-inch-an-hour rain will really take it out of a girl. (We're all fine, by the way.)
Something about medical service patients who are, in a word, all batshit crazy will take it out of a girl.
And there's something about learning entirely new protocols and care plans and how to take care of totally unfamilliar patients that will take it out of a girl, too. This week it's been urology patients; the specialty has moved to our unit to partner with neurology. And if you think that causes problems when we page people, because of the sound-alike qualities of "urology" and "neurology", you'd be right. We've started referring to them as "brains" and "bladders" to make things easier.
Guys who've had their prostates out will talk about *anything*. One gentleman compared his prostate exam to labor and childbirth. I did not laugh. Another regaled me with tales of where one finds blood after a prostate biopsy. I did not run out of the room screaming.
(And that crazy patient? The one I said no to? Was fired by her surgeon shortly thereafter. Sweet, sweet justification of my actions. Sweet.)
Don't get me wrong: I'm not complaining. I'm liking having to learn new things on the fly, and there's a lot of interesting stuff coming in with the medicine and surgery folks. Like Whipple procedures--I'd not heard of that since nursing school. I'm doing a lot of research between patient rounds and boning up on drugs I'm not familliar with. But it's exhausting.
How exhausting? It's 15:45 and I just got out of bed. Cancelled my workout with the trainer today, skipped eating, and slept. This is how tired I am: a box from Sephora arrived and I didn't open it right away. I laid back down on the couch and dozed off instead.
General surgery patients are heavy, primarily because they're not routine for me. Neurosurgery and neurology I could do in my sleep because, well, that's all I've done for nearly five years now. But surgery and medicine have all these new orders and care tracks and protocols and I'm just blown. Plus, they tend to get better faster, so instead of six high-acuity admissions in a day, we have seventeen low-acuity admissions and just as many discharges in the twelve hours.
Overall, though, it's fun. The surgery guys have great senses of humor and are good to work with: intelligent, humane, and good at returning pages. The urology guys are just as all-around good, plus they have a stable of nurses who are helping us out as we get comfortable with their patients.
I just wish I could take a nap in the middle of the shift. After a day when I start with five patients (usually one or two high-acuity neurosurgeries in there), discharge three, get three, discharge two of those, get two more, and pick up one last one at 1815, I'm *so* done.
I wonder what's in that box from Sephora.
Saturday, April 28, 2007
Rules of Nursing, Revised and Updated!
1. All together now: If you have to jack with it, it's wrong.
2. The amount of time it takes a patient to announce "I'm not a junkie!" is inversely proportional to the probability that the patient is indeed a junkie.
3. The amount of irritation a particular order, procedure, patient, or request will produce is directly proportional to the number of sleepless nights the ordering resident has had.
4. The messiness of handwriting is directly proportional to the difficulty in getting hold of the person who wrote the order.
5. The amount of feces a patient produces during a shift is inversely proportional to his level of consciousness.
6. The difficulty level of a drug calculation is directly proportional to the drug's dangerousness.
7. Benzoin never washes out.
8. Bile will always land on whatever is white.
9. The patient on several different interacting medications will always have a general practitioner who does not do blood levels of those medications.
10. Everything happens after 0400/1600.
11. The probability that a patient will survive a code is inversely proportional to the likelihood that they will be declared DNR.
12. Any attempt at efficiency will, sooner rather than later, be met with Three-Stooges-like complications.
13. The lift is never on the floor when you need it.
14. The high-risk profile for terminal illness includes a happy family, a good job helping others, and a cadre of devoted friends and relatives.
15. Elevators fail to work during codes.
2. The amount of time it takes a patient to announce "I'm not a junkie!" is inversely proportional to the probability that the patient is indeed a junkie.
3. The amount of irritation a particular order, procedure, patient, or request will produce is directly proportional to the number of sleepless nights the ordering resident has had.
4. The messiness of handwriting is directly proportional to the difficulty in getting hold of the person who wrote the order.
5. The amount of feces a patient produces during a shift is inversely proportional to his level of consciousness.
6. The difficulty level of a drug calculation is directly proportional to the drug's dangerousness.
7. Benzoin never washes out.
8. Bile will always land on whatever is white.
9. The patient on several different interacting medications will always have a general practitioner who does not do blood levels of those medications.
10. Everything happens after 0400/1600.
11. The probability that a patient will survive a code is inversely proportional to the likelihood that they will be declared DNR.
12. Any attempt at efficiency will, sooner rather than later, be met with Three-Stooges-like complications.
13. The lift is never on the floor when you need it.
14. The high-risk profile for terminal illness includes a happy family, a good job helping others, and a cadre of devoted friends and relatives.
15. Elevators fail to work during codes.
Friday, April 27, 2007
Say the word and be like me.
It's so fine; it's sunshine. It's the word "no."
A meditation on saying "no."
I had one of Those patients today. You know the sort; they come in with poorly defined abdominal pain that stays poorly defined and resists all efforts to diagnose it. The only thing that calms the pain is a patient-controlled pain pump with X number of milligrams every Y minutes (determined by the patient) with a Z bolus of A milligrams every B minutes.
You know the sort.
This one wanted to go smoke. Then she wanted to go to the gift shop. Then she wanted just to walk around outside. I told her she could do none of those things; that leaving the floor with that much narcotic was not allowed.
So she put an aide on the spot by asking *him* to take her out to smoke.
Which I called her on. Then she called the aide a liar, which I called her on. Then it became a huge joke, which I did not find funny.
The last straw, for That patient, was when I told her that, regardless of what she *wanted* to eat, she'd be getting a particular diet. Period. No argument.
Whereupon she, being an old hand at this hospital business, called the Big Boss and poured out her tale of woe. Oh, the cruel nurse! Oh, the inhumanity!
Immediate Boss dealt with it and came back with this ultimatum: either give up That patient and offer a "half-assed apology" or offer a "half-assed apology" (and I'm quoting, here) and go on for the rest of the shift.
I said "no."
As in, No, I will not apologize to the patient who will not follow the rules. As in, I was not rude or condescending or nasty; I simply stated how things would be. As in, No, That patient won't get an apology, and further, *you* get to handle her for the next four hours.
As in, No, I will not be abused in the name of customer service.
Because, you see, my job is not customer service. My job is to provide the safest and most therapeutic environment possible for my patients. If that means that they don't get to smoke their usual two packs a day while they're being evaluated for a duodenal perforation, so be it. I'm happy to offer nicotine replacement; it's their loss if they refuse.
My job is also to protect the people who have less power than me. If you call my aide a liar while trying to get him to do something he knows he can't, I'll call you on it. And if you continue to screw around, I will not tire of telling you "no."
The surgeon, thank God, is on my side.
The other nurses I work with are shocked. And admiring, that I had the huevos to say "no" to something that we'd all normally go along with in order to keep the peace.
I've had enough of saying "yes." It's time we, as a profession, got rid of this imagine of being pushovers who only want to please. I'm sure the first twenty-dozen nurses who refused to stand when the doctors entered the station got hell, as did the first twenty-dozen who refused to carry the MDs charts for them during rounds.
I'll take hell for saying "no." I've already defined my job; my bosses' job is to make sure I can do *my* job safely and without untoward interference.
I have the feeling I'll hear about this once Biggest Boss Of All gets back from vacation. In the meantime, I'll savor the feeling of "no."
A meditation on saying "no."
I had one of Those patients today. You know the sort; they come in with poorly defined abdominal pain that stays poorly defined and resists all efforts to diagnose it. The only thing that calms the pain is a patient-controlled pain pump with X number of milligrams every Y minutes (determined by the patient) with a Z bolus of A milligrams every B minutes.
You know the sort.
This one wanted to go smoke. Then she wanted to go to the gift shop. Then she wanted just to walk around outside. I told her she could do none of those things; that leaving the floor with that much narcotic was not allowed.
So she put an aide on the spot by asking *him* to take her out to smoke.
Which I called her on. Then she called the aide a liar, which I called her on. Then it became a huge joke, which I did not find funny.
The last straw, for That patient, was when I told her that, regardless of what she *wanted* to eat, she'd be getting a particular diet. Period. No argument.
Whereupon she, being an old hand at this hospital business, called the Big Boss and poured out her tale of woe. Oh, the cruel nurse! Oh, the inhumanity!
Immediate Boss dealt with it and came back with this ultimatum: either give up That patient and offer a "half-assed apology" or offer a "half-assed apology" (and I'm quoting, here) and go on for the rest of the shift.
I said "no."
As in, No, I will not apologize to the patient who will not follow the rules. As in, I was not rude or condescending or nasty; I simply stated how things would be. As in, No, That patient won't get an apology, and further, *you* get to handle her for the next four hours.
As in, No, I will not be abused in the name of customer service.
Because, you see, my job is not customer service. My job is to provide the safest and most therapeutic environment possible for my patients. If that means that they don't get to smoke their usual two packs a day while they're being evaluated for a duodenal perforation, so be it. I'm happy to offer nicotine replacement; it's their loss if they refuse.
My job is also to protect the people who have less power than me. If you call my aide a liar while trying to get him to do something he knows he can't, I'll call you on it. And if you continue to screw around, I will not tire of telling you "no."
The surgeon, thank God, is on my side.
The other nurses I work with are shocked. And admiring, that I had the huevos to say "no" to something that we'd all normally go along with in order to keep the peace.
I've had enough of saying "yes." It's time we, as a profession, got rid of this imagine of being pushovers who only want to please. I'm sure the first twenty-dozen nurses who refused to stand when the doctors entered the station got hell, as did the first twenty-dozen who refused to carry the MDs charts for them during rounds.
I'll take hell for saying "no." I've already defined my job; my bosses' job is to make sure I can do *my* job safely and without untoward interference.
I have the feeling I'll hear about this once Biggest Boss Of All gets back from vacation. In the meantime, I'll savor the feeling of "no."
Wednesday, April 25, 2007
*smack* *munch* Mmmm...new nurses.
That's a joke, people.
John (for whom I have immense respect and liking) has a post up on "lateral violence", aka "nurses eat their young with sprouts and bleu cheese." He posts some sobering stats on how many new nurses (defined here as nurses within the first couple of years of licensure) leave the profession entirely or change jobs.
Not to disagree entirely with John's point, but I have a thought on a couple of other issues that face new nurses. I thought I'd expound. Of course I did.
Issue Number One: Nobody Really Knows What The Hell It Is We Do.
We dare to care, yes. We dare to cry. We dare to work out BSA and dosages for neonates in a code. We dare to keep up with changes in legislation. We dare to influence that legislation. We dare to advocate for abused patients. We dare to work in a profession that is historically undervalued. We dare to protect our patients from doctors' errors. We dare to report our own.
In short, we do a whole lot more than caring and crying.
Yet, when I started nursing school, I was the only person in a class of forty who said something other than "I want to help people."
Nursing students are no less clueless than the rest of society. I would estimate that ninety percent of the folks I went to school with thought that a person's warm-fuzzosity was the primary determinant of how they'd do as a nurse. And all of those people got whacked upside the head with the reality of how tricky the job is--not just from the standpoint of interacting with sick people, but from the standpoint of having to be a scientist.
Aside from the one woman who went into school "to meet doctors" and the other who wanted her husband to stop bugging her about getting a job, *all* of the people who wanted to "help others" have left the profession.
All of them. That's fifteen nurses (of the ones that finished school) who have gone back to accounting, or bank tellering, or whatever they were doing before. I am one of six (SIX!) students from my graduating class who is still a nurse. Nobody, apparently, knew that it would be as hard and as intellectually demanding as it is.
At the same time, I'm watching smart young feminists of my acquaintance not enter nursing because of the helpmeet stereotype. Frankly, what this profession needs more of is smart young feminists. Yet we're not attracting them, because nursing is still seen as a pink-collar, nearly-service-industry, "helping" profession. When I talk to women who are working toward their premed degrees about what I do for a living, they're gobsmacked to discover that modern nursing is a hell of a lot more like their concept of being a doctor than they thought.
Solution? We need to be realistic about what we do. We need to tell people, every chance we get, that we are intelligent, trained, scientific professionals who are also able to steer a family through a health crisis or advocate for a rape victim. I am eternally grateful for Pal Angie, who will be getting a newly-minted RN this summer (hooray, Angie!) and who is one of the smartest, toughest, feminist, most realistic people I know. If more people could see nurses like her, we'd have no problem with a shortage.
And if more nurse-wanna-bes understood that it ain't all hugs, we'd have fewer people who ought to be somewhere else.
Harsh, but true.
Issue Number Two: It's About The Stupid Management
Sometimes I feel like a cross between Joe Hill and Emma Goldman, with the Pinkertons about to bust down my door, but it's true: Hospital management is hostile to nurses. Period.
A friend of mine who's also an RN got offered a fantastic bonus for signing on with a particular hospital which shall remain nameless. She showed up on the floor the first day after two weeks of orientation to find herself in charge of one practical nurse and twelve patients. Twelve. All of whom were in varying states of circling the drain because of nursing shortages at that hospital. She walked out after that first day and came to our facility, which (at the time) still cared about staffing rather than the latest technological widget.
We as nurses need to do two things to fix this problem: First, we need to stop signing up for extra work. When I see a nurse who's working ten days in a row without a day off, I don't see a dedicated professional. I see a person with serious issues about saying "No."
Quite frankly, the world will not end if we all start saying "No." The hospital will hire agency nurses or more full-timers, or start paying attention, at least, to staffing levels. Management might actually have to come in and work--and that, my friends, is a truly marvelous feeling, to watch your manager wipe ass for twelve hours because he hasn't had the huevos to hire new people.
Second, and more importantly, we need to agitate for safe staffing levels. When I say "agitate", I mean everything from my own technique (which involves yelling if necessary) to the technique of calmer colleagues (who speak in front of the state legislature). Every nurse can make a difference at some level in this fight. If you're crazy about writing letters and emailing representatives, you can do that. If you're nuts for making middle management uncomfortable, you can do that. And if you get a warm, fuzzy glow from saying "No" to extra shifts, you can do that.
We as nurses do need to shut the hell up and stop putting new nurses through a gauntlet. Nobody's going to be tougher, or faster, or smarter for being abused. There are, however, *systemic problems* that I think are a larger threat to the profession as a whole. We need to spend the breath we'd use debating how, exactly, we eat our young fixing those.
John (for whom I have immense respect and liking) has a post up on "lateral violence", aka "nurses eat their young with sprouts and bleu cheese." He posts some sobering stats on how many new nurses (defined here as nurses within the first couple of years of licensure) leave the profession entirely or change jobs.
Not to disagree entirely with John's point, but I have a thought on a couple of other issues that face new nurses. I thought I'd expound. Of course I did.
Issue Number One: Nobody Really Knows What The Hell It Is We Do.
We dare to care, yes. We dare to cry. We dare to work out BSA and dosages for neonates in a code. We dare to keep up with changes in legislation. We dare to influence that legislation. We dare to advocate for abused patients. We dare to work in a profession that is historically undervalued. We dare to protect our patients from doctors' errors. We dare to report our own.
In short, we do a whole lot more than caring and crying.
Yet, when I started nursing school, I was the only person in a class of forty who said something other than "I want to help people."
Nursing students are no less clueless than the rest of society. I would estimate that ninety percent of the folks I went to school with thought that a person's warm-fuzzosity was the primary determinant of how they'd do as a nurse. And all of those people got whacked upside the head with the reality of how tricky the job is--not just from the standpoint of interacting with sick people, but from the standpoint of having to be a scientist.
Aside from the one woman who went into school "to meet doctors" and the other who wanted her husband to stop bugging her about getting a job, *all* of the people who wanted to "help others" have left the profession.
All of them. That's fifteen nurses (of the ones that finished school) who have gone back to accounting, or bank tellering, or whatever they were doing before. I am one of six (SIX!) students from my graduating class who is still a nurse. Nobody, apparently, knew that it would be as hard and as intellectually demanding as it is.
At the same time, I'm watching smart young feminists of my acquaintance not enter nursing because of the helpmeet stereotype. Frankly, what this profession needs more of is smart young feminists. Yet we're not attracting them, because nursing is still seen as a pink-collar, nearly-service-industry, "helping" profession. When I talk to women who are working toward their premed degrees about what I do for a living, they're gobsmacked to discover that modern nursing is a hell of a lot more like their concept of being a doctor than they thought.
Solution? We need to be realistic about what we do. We need to tell people, every chance we get, that we are intelligent, trained, scientific professionals who are also able to steer a family through a health crisis or advocate for a rape victim. I am eternally grateful for Pal Angie, who will be getting a newly-minted RN this summer (hooray, Angie!) and who is one of the smartest, toughest, feminist, most realistic people I know. If more people could see nurses like her, we'd have no problem with a shortage.
And if more nurse-wanna-bes understood that it ain't all hugs, we'd have fewer people who ought to be somewhere else.
Harsh, but true.
Issue Number Two: It's About The Stupid Management
Sometimes I feel like a cross between Joe Hill and Emma Goldman, with the Pinkertons about to bust down my door, but it's true: Hospital management is hostile to nurses. Period.
A friend of mine who's also an RN got offered a fantastic bonus for signing on with a particular hospital which shall remain nameless. She showed up on the floor the first day after two weeks of orientation to find herself in charge of one practical nurse and twelve patients. Twelve. All of whom were in varying states of circling the drain because of nursing shortages at that hospital. She walked out after that first day and came to our facility, which (at the time) still cared about staffing rather than the latest technological widget.
We as nurses need to do two things to fix this problem: First, we need to stop signing up for extra work. When I see a nurse who's working ten days in a row without a day off, I don't see a dedicated professional. I see a person with serious issues about saying "No."
Quite frankly, the world will not end if we all start saying "No." The hospital will hire agency nurses or more full-timers, or start paying attention, at least, to staffing levels. Management might actually have to come in and work--and that, my friends, is a truly marvelous feeling, to watch your manager wipe ass for twelve hours because he hasn't had the huevos to hire new people.
Second, and more importantly, we need to agitate for safe staffing levels. When I say "agitate", I mean everything from my own technique (which involves yelling if necessary) to the technique of calmer colleagues (who speak in front of the state legislature). Every nurse can make a difference at some level in this fight. If you're crazy about writing letters and emailing representatives, you can do that. If you're nuts for making middle management uncomfortable, you can do that. And if you get a warm, fuzzy glow from saying "No" to extra shifts, you can do that.
We as nurses do need to shut the hell up and stop putting new nurses through a gauntlet. Nobody's going to be tougher, or faster, or smarter for being abused. There are, however, *systemic problems* that I think are a larger threat to the profession as a whole. We need to spend the breath we'd use debating how, exactly, we eat our young fixing those.
Tuesday, April 24, 2007
How not to be impressive.
It does not impress me if a nurse routinely complains at 1430 that she hasn't had a chance to open her charts. It makes me wonder where she learned her time-management skills.
It does not impress me if a nurse tells me he's never made a medication error. It makes me wonder how many of those medications he's taken himself.
It does not impress me if a nurse on our floor tells me she never has time for lunch. I qualify that with "on our floor" because we are very serious about food. See time-management skills, above.
It does not impress me if a nurse complains constantly about the fact that one of these days, he's gonna get sued and lose his license and isn't the culture of lawsuit-happiness awful. If that's his main focus, I wonder what and how he's charting and what the hell he's doing in the room.
It does not impress me to hear a nurse deny that she's wrong.
It does not impress me to learn of a nurse's difficult relations with doctors. There's no reason not to get along with doctors, with the possible exception of the occasional total nutcase. Even if you get off on the wrong foot with each other, careful negotiation can make a good working relationship possible. If you can't get along with any of 'em, the problem is you.
It makes me sad and does not impress me when a nurse obviously hates everything about nursing. I don't care if you felt trapped ten years ago when you got your RN; you can certainly afford to change now. If you hate it that much, take accounting classes or learn to throw pots on the wheel.
Drama fails to impress me. Totally.
What does impress me, and what I'd like to be eventually, is the sort of nurse whose patients rarely end up in the ICU, because she's caught problems early. I'd like to end up as one of those nurses whose gut feelings get taken seriously by residents and attendings alike, because he's been so careful in his assessment. I'd like to be one of those nurses whose charting is so complete and careful that you can tell, a week later, exactly what's been going on. I'd like to be the nurse who doesn't get flowery accolades from management, but whose patients always request her when they return after surgery.
I am very, very lucky to work with a passel of the latter sort of nurse and only a couple of the first sort.
But jiminy cricket, I need to work on my charting.
It does not impress me if a nurse tells me he's never made a medication error. It makes me wonder how many of those medications he's taken himself.
It does not impress me if a nurse on our floor tells me she never has time for lunch. I qualify that with "on our floor" because we are very serious about food. See time-management skills, above.
It does not impress me if a nurse complains constantly about the fact that one of these days, he's gonna get sued and lose his license and isn't the culture of lawsuit-happiness awful. If that's his main focus, I wonder what and how he's charting and what the hell he's doing in the room.
It does not impress me to hear a nurse deny that she's wrong.
It does not impress me to learn of a nurse's difficult relations with doctors. There's no reason not to get along with doctors, with the possible exception of the occasional total nutcase. Even if you get off on the wrong foot with each other, careful negotiation can make a good working relationship possible. If you can't get along with any of 'em, the problem is you.
It makes me sad and does not impress me when a nurse obviously hates everything about nursing. I don't care if you felt trapped ten years ago when you got your RN; you can certainly afford to change now. If you hate it that much, take accounting classes or learn to throw pots on the wheel.
Drama fails to impress me. Totally.
What does impress me, and what I'd like to be eventually, is the sort of nurse whose patients rarely end up in the ICU, because she's caught problems early. I'd like to end up as one of those nurses whose gut feelings get taken seriously by residents and attendings alike, because he's been so careful in his assessment. I'd like to be one of those nurses whose charting is so complete and careful that you can tell, a week later, exactly what's been going on. I'd like to be the nurse who doesn't get flowery accolades from management, but whose patients always request her when they return after surgery.
I am very, very lucky to work with a passel of the latter sort of nurse and only a couple of the first sort.
But jiminy cricket, I need to work on my charting.
Thursday, April 19, 2007
"what i don't know outweighs so much of what i do know, sometimes it's hard to believe"...
I have to, *have* to address this.
New nurses are ignorant.
So are old nurses who are faced with something they've never dealt with before.
So are medium-aged nurses who have to keep up with new technology.
So are doctors, old and new, rusty and in-practice.
Part of the practice of nursing is scrunching out ignorance: your own and other people's. I would argue that the most important thing that a nurse does is scrunch out that ignorance by giving her* patients the tools and knowledge to deal with their conditions. The second-most important thing she does is squish her own ignorance flat under the weight of her own research, learning, and auto-didact-icism.
Do not ever let your ignorance paralyze you. Hell, if I dwelled every day on how little I actually know about neuroscience, I'd never get out of bed. (Or, at least, I'd have another good excuse for not getting out of bed.) What I do know, I know really well--and I can put it into language that a mentally-deficient turnip could understand. What I don't know I'm not afraid to admit, even to an anxious patient.
Where nursing students excel is in the almost eidetic recall of new stuff a lot of the rest of us have missed. Where they excel is in the energy they put into learning new stuff. They also kick ass at taking a look at The Way Things Have Always Been Done and asking "Why?"
Don't let the fear of your own ignorance paralyze you, whether you're a brand-new nurse, or a brand-new student, or an old-guard nurse trying something new. The absolute worst thing that will happen to you if you show your ignorance is that you'll feel like an idiot for a few minutes. Nobody's going to die. Nobody's even going to get hurt. More than likely, you'll make some pedantic nurse's or doctor's day by giving them the chance to explain something near and dear to them.
I once asked an endocrinologist a fairly simple (I thought) question about something endocriny. He treated me as though I had a much broader base of knowledge on the subject than I actually do and lectured me for three minutes on the ins and outs of that particular problem. (What the original question was has been burnt out of my head by the answer.) Even after he left the English language and started saying "Gleep! Waggado, florischepup mmm nnaaagh wazuuuuu weeeep, *click*!!" I sat there and looked interested and nodded. I learned more than I had in a week that day, even without taking into account the detours I took through Google and dictionaries as I looked up the words he'd used.
I am also now his very favorite nurse. He mostly speaks real human speech to me, even.
That's a good lesson on admitting your ignorance. Remember: if it's too humiliating, you can always get Freixenet Cordon Negro in those itty-bitty bottles for after work.
*Standard disclaimer on using female pronouns to label nurses goes here.
New nurses are ignorant.
So are old nurses who are faced with something they've never dealt with before.
So are medium-aged nurses who have to keep up with new technology.
So are doctors, old and new, rusty and in-practice.
Part of the practice of nursing is scrunching out ignorance: your own and other people's. I would argue that the most important thing that a nurse does is scrunch out that ignorance by giving her* patients the tools and knowledge to deal with their conditions. The second-most important thing she does is squish her own ignorance flat under the weight of her own research, learning, and auto-didact-icism.
Do not ever let your ignorance paralyze you. Hell, if I dwelled every day on how little I actually know about neuroscience, I'd never get out of bed. (Or, at least, I'd have another good excuse for not getting out of bed.) What I do know, I know really well--and I can put it into language that a mentally-deficient turnip could understand. What I don't know I'm not afraid to admit, even to an anxious patient.
Where nursing students excel is in the almost eidetic recall of new stuff a lot of the rest of us have missed. Where they excel is in the energy they put into learning new stuff. They also kick ass at taking a look at The Way Things Have Always Been Done and asking "Why?"
Don't let the fear of your own ignorance paralyze you, whether you're a brand-new nurse, or a brand-new student, or an old-guard nurse trying something new. The absolute worst thing that will happen to you if you show your ignorance is that you'll feel like an idiot for a few minutes. Nobody's going to die. Nobody's even going to get hurt. More than likely, you'll make some pedantic nurse's or doctor's day by giving them the chance to explain something near and dear to them.
I once asked an endocrinologist a fairly simple (I thought) question about something endocriny. He treated me as though I had a much broader base of knowledge on the subject than I actually do and lectured me for three minutes on the ins and outs of that particular problem. (What the original question was has been burnt out of my head by the answer.) Even after he left the English language and started saying "Gleep! Waggado, florischepup mmm nnaaagh wazuuuuu weeeep, *click*!!" I sat there and looked interested and nodded. I learned more than I had in a week that day, even without taking into account the detours I took through Google and dictionaries as I looked up the words he'd used.
I am also now his very favorite nurse. He mostly speaks real human speech to me, even.
That's a good lesson on admitting your ignorance. Remember: if it's too humiliating, you can always get Freixenet Cordon Negro in those itty-bitty bottles for after work.
*Standard disclaimer on using female pronouns to label nurses goes here.
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