Monday, November 26, 2007

You must immediately click the following link...

To Digital Cuttlefish.


I don't know how I lived without the Cuttlefish's blog for so long.

(Be certain to read the poem linked as Cute-Cute-Cute.)

Woo doggies.

I do brains. Brains and spines. It's what I do. It's why I titled my blog "Head Nurse." Because I do brains. And spines.

Except lately I've been doing a lot more than brains and spines. Kidneys, for instance, and intestines. And weird plastic surgery dealios that involve, like, seven incisions in somebody's head, all intended to rebuild bits that have been lost to gunshots or cancer or accident.

So I've found myself having to do things that I'm not exactly comfortable with lately, and I've come up with some new tips and tricks. They're old news for those of you who handle a lot of bizarre surgery patients ("bizarre" in this case modifying "surgery"), but they're new to me.

Tip the First: Label IV drips in more than two places.

The rule is to label your pump and your IV line if you're running, say, chemotherapy or total parenteral nutrition, two things that should not be combined with anything else. Normally those lines are labelled on the IV pump itself and then below the IV pump in one spot, using fabric tape and permanent marker or a pre-printed label in yellow or red.

I've found over the last couple of months that that is not enough labelling for somebody like me. I now label TPN and Weird NonMixable Drips in four or five places, running those labels straight down the line. It's not such a big deal if you're infusing, say, normal saline and IV immunoglobulin, but if you've got a four-channel pump with four fluids plus piggybacks, it helps.

Tip the Second: Label the drains coming out of your patient.

Again, I'm used to three or four drains at the most, and those well-spaced: maybe one at the head, one in the belly, and one coming out of the person's lumbar spine. I was confronted late last month with a patient who had ten (10) drains coming out of her belly alone. I'm not counting the ones coming out of her back, or the ones attached to the Wound-Vac.

None of the drains were labelled, yet there was an order that said, "Flush PAD with 30 ccs NS q 8 hrs, dwell for one hr, drain." Um. Lessee...three PADs there and no clue which one to flush. Flush 'em all? Flush one every eight hours? Or ask the resident? I went with door number three, then labelled the drain we were supposed to be flushing. I also labelled the lines with where they went (JP, Jvac, Hemovac, Wound-Vac) so there'd be less tracing back. It also helped differentiate the two drains that had exactly the same tubing but different uses when the only distinguishing marks were covered by tape and connectors.

Tip the Third: Warn the next shift about that abscess.

If you know your opposite number on the night shift will have to irrigate and re-dress an abscess or undermining decubitus, have the Vicks Vaporub right there at the door when they walk in. This is one of those "do unto others" things I wish somebody had done for me. There's nothing quite like encountering a fist-sized hole in somebody's belly or a stage IV undermining bedsore without proper preparation.

Tip the Fourth: Warn the next shift about that resident.

We have our residents trained well. The same can't be said for the residents who are, for our unit, off-service. It's only politic to warn the oncoming shift about the resident who's paranoid, suspicious, and has a God complex. I was the first person to encounter him and thought he was being ironic. Wups.

And, finally, Tip the Fifth: Iodoform, Aquacel, and various other specialty dressings never go as far as you think they will.

Let's say you've got a wound that's just about big enough to swing a cat in. Let's further assume you have to pack that sucker with some sort of wound-packing material. If you already have three containers of that packing in the room, take in a fourth. If there are already four in there, take in a fifth. Have an extra in your pocket just in case. This is especially important if your patient has a live flap from, say, their shoulder to where an ear used to be that has to be wrapped with petrolatum gauze, as that stuff's a beast to work with.

It's been an interesting couple of months. Things'll probably start getting back to normal soon, as the construction that's sent Bizarre Surgery Patients to our unit is almost done. I'll miss the variety. I think I've grown a third hand through dealing with all this new stuff, and I'm hoping that sticks around. What I *won't* miss is seeing patients with half a face, or faces that are attached to arms or shoulders or chests.

Who knew that a subtotal lobotomy patient could seem so peaceful and normal?

Friday, November 23, 2007

With regards to Jill Sobule

I once saw a photo of a poster, somewhere online, that showed a large Malamute and the words "LOOK AT THIS DOG."

The text below read like your typical Lost Dog advertisement, except that it consisted of things like "Isn't this a MAGNIFICENT FUCKING DOG?? I love this dog. He is so damn cool. Last seen being COOL in my huge-ass backyard, which is what he does EVERY DAY."

I am totes in love with my dog.

He grumbles. He dances. He makes "hmmmMMMMmmmrrrgh" noises when I rub his ears. Sometimes he invites me outside to play by bringing every single damn chew toy and rubber ball and bone and bull penis (dried) and stick and rock in the back yard up to the door and dropping it, then looking hopeful. "Herd Ball? Can we play Herd Ball, please? Pleeeeeeez?" (Thanks to Kris for the name of that game.)

He has enormous shoulders, big brown eyes, and blond hair. What more could I want in a male that takes up most of my bed? Yeah, he's got a hairy back, but hey. He only eats once a day and that's dry kibble, so I know he won't drink the last beer.

And he likes me to scratch his belly. There's nothing better after a long day than coming home and letting him in and having him roll over with one paw up, asking for Belly Rubs. Rub Mah Belly, Human!

He has a magnificent bark. I love to hear him bark, unless it's at 2 am. And we're having a problem with the "bark when people come to the door" thing, as he normally barks as they're driving away. Yeah, the Mansons could come in and he wouldn't mind, provided he got Belly Rubs, but he's learning.

He doesn't chase the cat. He doesn't chase squirrels. So far, he has not peed once in the house (we'll see how that goes once I get a Christmas tree). He's nice to strangers, unless they're skeevy. If they're skeevy, he stares at them with his ears pricked. If they're not skeevy, or if they're friends, he lets his right ear flop over or to the side. He's completely smitten with the pug next door. He licks my face when I'm feeling bad.

I am totally, *totally* in love with my dog.

LOOK at my dog. Isn't he magnificent? He is. Yes, he is.

Tuesday, November 20, 2007

Holiday recipe #1: Stuffing for Residents

Chop two white onions and five stalks of celery. Sweat in half a stick of butter until soft.

Dump into a large bowl. Refill the saute pan with a pound of chopped mushrooms and melt them into a stick of unsalted butter.

Boil six cups of chicken stock. Add one stick of unsalted butter.

Toast one pound of chopped pecans at the same time you cook one pound of lean bacon in the oven.

Open two of the largest bags of Pepperidge Farm stuffing mix you can find. Use the homestyle stuff, not the cornbread stuffing, which is too sweet.

Dump them into the bowl on top of the onions and celery.

When the bacon is crisp, drain it. Add bacon, mushrooms, and pecans to the bowl of stuffing. Be glad you got the largest mixing bowl Target sells.

Pour chicken broth mixture over your stuffing and mix well. Bake for an hour or so in a casserole pan or six, until the top is crispy and the house smells marvelous.

Will feed sixteen nurses, twenty normal people, or three and a half residents.

Sunday, November 18, 2007

Burnt. Out.

It's that time of year again. I'm feeling burned out about my job.

What do you do when you feel burned out?

Sunday, November 11, 2007

The eleventh hour of the eleventh day of the eleventh month.

Wilfred Owen

Dulce Et Decorum Est

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of disappointed shells that dropped behind.

GAS! Gas! Quick, boys!-- An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling
And floundering like a man in fire or lime.--
Dim, through the misty panes and thick green light
As under a green sea, I saw him drowning.

In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.

If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil's sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,--
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est
Pro patria mori.

Wednesday, November 07, 2007

White girl, white rice, white wine edition: I threw away my TV, so...

...I can't watch Grey's Anatomy any more. Therefore, a list of things I do when I'm sick and tired of being a nurse.

Surf YouTube for Harry Potter tribute videos. Love that song. Love it.

My jeans are falling off of me, thanks to weeks of getting the yard in shape, so I might not qualify for Manolo for the Big Girl any more...but it's still a good read. You might see someone you know in the postings.

Gala Darling. Still my 3 a.m. fix for things to make me cheerful.

I own one bag for work, one for not-work, and one for play. Why, then, do I read Bag Snob? For the writing, friends.

No, you can't wear most of the makeup to work, and the latest mailer is silly beyond belief. Still, Sephora has the best deals on good soap guaranteed to get the smell of formalin/blood/poop off'a ya.

No, you can't wear these clothes to work, but when is a girl's life ever all work? StyleBites.

Dumb Little Man is not.

Canned goods are always a good investment: the story of my life! Frugal Fag has the lowdown. Or the down-low.

Food. Or not. The Food Whore is always a good read.

She's like me. Except she's a doctor, and all.

And this is what I do when I'm not at work. Or walking Max, or washing the car, or making salmon with cream-garlic sauce.

Thursday, November 01, 2007

Change O' Shift!

Right here.