Tuesday, April 15, 2008

A Day In The Life

Getting Better All The Time

There's been an outbreak of what I'm convinced is norovirus at work. Norovirus is That Nasty Stomach Bug family of viruses--the sort of bug that incubates in a day or so and takes a day or two to resolve. Since all nurses work some degree of sick most or all of the time, it makes sense that something that could only be eradicated by bleach and scrubbing might be lurking in the viral soup that is our hospital.

My turn was yesterday. I was pretty damned puny, but Chef Boy brought over bread and ginger ale, and I ate soup and laid on the couch, making noises like the cartoon woman in the introduction to "Mystery!" Today I am better, though not enough better to, say, climb the Matterhorn or work out. I shall (she says, determinedly) finish the laundry and nap.

Sky of Blue, and Brain of Green

What makes your brain the color and consistency of pea soup in about three days?

I wish that were a riddle. Instead, it's something that happened to one of my patients (now dead). Mayo took their sweet time over the biopsies and sent back a detailed pathology report that said, in essence, "We have no fucking clue. Try Hopkins."

It's been about five years since we had a patient who had a true God Only Knows diagnosis. That last one garnered laurels for a couple of fellows in neurology who presented a paper on the patient's decline. What it did not get anybody was a name for that person's condition, a cause, or a cure. 

Dr. Dink, the psychiatrist who writes my prescriptions for Happy Brain Pills, said, "Well, those are the interesting cases, you know." Yeah. Interesting. Because it's never any fun at all when somebody gets better. That gave me an insight into the shrink personality.

Fixing A Hole

Finally, a non-neuroscience happy ending. 

A couple years ago we had a patient with a big hole. I mean a *big* hole, the sort of thing you could easily put your head in. Mediastinitis, it's called, and it's an infection in your chest that's usually caused by rupture of one of the organs there. In this person's case, it was the result of surgical infection. The hole went from the middle of the breastbone down into the belly and tunnelled every which way. It was so badly infected, necrotic, and generally nasty that it took weeks and weeks to heal, and we had to repaint the room after the patient was gone--it smelled that bad.

He's fine. Two weeks ago, he came breezing in, more than a hundred pounds lighter and quite fit, totally recovered, and with only a half-dollar-sized, puckered white scar on his chest to show for his ten weeks of hell. That was nice.

Run For Your Life If You Can, Little Girl

In non-nursey news, I bought a treadmill. I am totally, totally in love with my treadmill, to the extent that I get up a bit earlier every day than I used to and hurple along for a few minutes before I get ready for work. It's quite fine. The cat has no opinion on it, while the dog looks at it with deep suspicion and loathing, but does not actually run off when I start it up. 

The damned thing weighs 300 pounds and has a control panel that looks like it belongs on the bridge of the Enterprise. I haven't yet discovered how to make it do laundry, but it does nearly everything else. It took two guys with experience in the process an hour and much multilingual cursing to put it together and get it working. Man, I love my treadmill.

You Like Me Too Much

I've finally had--and gotten rid of--my first patient-stalker.

It happens to everybody at some point: you take care of a patient who decides for some reason that you're the be-all, end-all, and that (to add to the weirdness) they simply must hang out with you outside of work and be your babydoll. This probably happens much more often to people in the brain business (be it psych or neuro), but hadn't as yet happened to me. 

Well, now it has. A traumatic brain injury will make a person think anything's possible. Thankfully, a combination of carefully-timed hiding in utility rooms and non-diplomatic "go aways" has made that patient, well, go *away*. 

If this ever happens to you, be aware: It's not always something you can predict or prevent. Especially with brain-injured patients, there's not going to be a way to control their reactions to your actions. The simple act of changing a dressing can, for them, become a declaration of your undying devotion. The best way to handle it is the way you'd handle a recalcitrant child: with firm repetition and without panic.

The End.


Penny Mitchell said...

What does it say about me that the first thing I thought about the subtitle was, "Fixing A-Hole" would have been more fun?

Anonymous said...

What makes your brain the color and consistency of pea soup in about three days?

I've seen that happen to 2 patients after snorting heroin. Liquifies the brain.