The stupid: It BURNS.

This has been One Of Those Weeks. The level of Stupid has gotten to the point that, if somebody doesn't do something soon, the Stupid will all roll together into one big ball of Damn That Was Dumb and there'll be a cataclysm.

For instance, Doctor Fuquad, you should probably not put a luer-lock access on to an arterial line. (For you non-medical types, an arterial line is just what it sounds like: a big IV-type thing that goes into an artery in your wrist so we can monitor your blood pressure directly during surgery.) For one thing, if you're monitoring pressures with an A-line, the luer-lock access will screw things up and make it look like the patient is running a blood pressure of 264/264. For another, and here is where I start to get all-cappy, YOU ARE NOT SUPPOSED TO PUT ANYTHING INTO AN ARTERIAL LINE EVER EVER EVER AND PUTTING AN ACCESS ON ONE MIGHT CONFUSE PEOPLE.

Let's make it simple, Doc: arterial lines are to be flushed only with pressure bags through pressure lines and are supposed to be directly connected to whatever they're going to. Luer-lock IV accesses are only for intraVENOUS access and are meant to allow you to shoot drugs through them. YOU ARE A MORON.

Gracious. Was that a rant? I think that was a rant.

*ahem*

Okay, boys, second thing: If you've done belly surgery on a patient, and that patient has developed a rigid abdomen and a sharply falling hematocrit about two hours after surgery, please don't keep that patient in the CCU for eight more hours to see if the bleeding will stop on its own.

(Yes, I just said that. And I just put my head in my hands In Remembrance Of Things Stupid.)

Ten hours after surgery, things were going.....badly for that poor bastard. Dr. Fuquad's brother, Dr. Diqhed, looked with some surprise at the lab values that were incompatible with life. A hemoglobin of five-and-a-half and a pH of seven-point-one? (For you non-medical types, these lab values are both fatal and entirely preventable. If you're not STUPID.) Well, then! Let's pour eight fucking units of blood into this guy using pressure bags, and if we don't have enough pressure bags, let's have Jo just stand there and squeeze!

And let's watch the blood we pour into the patient pour straight out into his already board-like belly!

Dr. Diqhed stopped by the unit after his patient's second surgery and expressed surprise at how well the patient looked. I couldn't stop myself--I hate this guy; he's an attending who should be weaving baskets--and said, "Yeah, it's amazing how great people do ONCE YOU STOP THE BLEEDING." (YOU MORON)

Uh, oh. Ranty again. So very sorry.

*koff*

And, finally, Manglement At That Other Hospital? It doesn't matter how sick your immunocompromised patient is with his widely-disseminated herpes simplex: you probably shouldn't put him into a unit meant for people who are seriously immunocompromised. Because if you do, all those poor bastards will be showing up at Sunnydale's CCU, medevaced in with screaming disseminated herpes simplex infections. It really doesn't matter how much negative pressure you have and how much your nurses scrub; that shit will travel.

Herpes encephalitis is bad enough. Herpes encephalitis combined with a cutaneous herpes outbreak bad enough to obscure major anatomical landmarks is worse. Like, if I can't see the person's navel for the blisters, that person is fucking SICK. And, if not for the level of MORON at your fine establishment, this could've been prevented.

*rubs eyes*

Every morning between three-thirty and five I get a little shirty and short-tempered. This week's been worse. I only cry when I'm angry or frustrated, and today I found myself sitting in the locker room on a bench, facing the wall, trying to decide whether breaking my hand by punching that wall was worth it, or whether I should just sacrifice my mascara to the Stupid.

I ended up having some Gatorade and a chicken sandwich and going back to work. Sometimes there isn't enough time to get upset about The Stupid; you just have to try to fix it.

Aaaaaand as an antidote for that last post, possibly the weirdest rendition of "Working in a Coal Mine" ever. It's Swedish.

Speaking of Learning Experiences....

I intend the following as a comfort, not as a cautionary tale. If ever you feel like you've really blown it, come on back and re-read this entry.

It was one of those days with a vengeance. We were short on both sides of the staffing sheet, had a unit full of high-acuity patients, it was a weekend, and I was in charge of the floor. Any one of those things would be a recipe for suckage, but combine them all (because I am *not* a good charge nurse *at all*) and you have pure, unmitigated Hell.

It was so bad that I got on the horn and had lunch delivered, because I knew nobody would have time to even hit a vending machine.

So. It's a bad, crazy, things-going-wrong-everywhere day. One of our patients took a sudden turn for the worse and had to have a lumbar tap in order to get some cerebrospinal fluid for various tests.

Now, CSF is considered a "precious" fluid. It's hard to get, you don't want to take too much of it at once, and it's very delicate. It has to make it to the lab in, like, ten minutes or it's no good for testing.

Our patient not only was a hard tap, she had to be tapped under fluoroscopy. That means necessary exposure to X-rays, which you want to avoid if at all possible.

We sent the patient down to radiology and she had the tap done. The chart came back up with the patient, we put her to bed and stuck the chart in the rack, and went on with the day. 

(You can see where this is going, right?)

Lab samples have to be labeled in a particularly tricky way. For that reason, it's up to the nurse to label the samples on the floor, in the patient's presence, while looking at the armband on the patient's wrist. If you have a sample that's been drawn somewhere else, there are a couple of unique identifiers that are slapped onto the sample tubes, but the rest of the labeling and sending the samples to the lab are the floor nurse's responsibility.

(Now it's all coming clear, isn't it?)

The CSF that had been drawn, with great difficulty under X-ray, and with the patient heavily sedated, sat in the chart in a plastic bag for seven hours.

Seven hours.

And it was my fault. Yeah, yeah, the floor nurse should've checked the chart, but *I* was charge and had had the chart in my hands multiple times in that seven hours. I never once double-checked, as I was supposed to, that the samples had actually been sent. So, when the lab called to ask where in blazes those samples were, I was flummoxed.

Until I opened the chart. Then I was queasy.

(See what I mean about Learning Experience, Nuclear-Grade?)

I did what I had to do: I called the doc. The conversation went something like this:

Doc on phone, returning page: "This is Scott."

Me, shuddering internally: "Hey, Scotty. You wanna yell at me now, or yell at me after you find out how bad I fucked up?"

Doc: ".... ..... ......shit. Jo, what happened?"

Me: "That CSF didn't get sent. It's still in the bag on my desk."

Doc: "Oh, that's fine. We just need it for (insert name of obscure test here), and it doesn't have to be fresh for that."

Me, weak with relief: "Oh, thank God. Okay, then; sorry to scare you."

Doc: "No problem. Boy, am I glad it wasn't something important."

Me: "Meee tooo, Scotty. Me too."

I got really lucky. More importantly, our patient got really lucky: she didn't have to be exposed to ionizing radiation again, didn't have to get tapped again, and the thing that was wrong with her wasn't going to get worse with a seven-hour delay in test results.

Nevertheless, the point here is that I Fucked Up. Royally. I have been doing this, as I've pointed out in other places, for seven years. I *know* what the drill is with lab samples. I *know* how to take care of them. And yet, with the stress of the day, all of that went out the window and I made a huge, potentially damaging mistake.

Next time I'll be more paranoid. I won't assume that the patient's nurse has checked the chart; she might be too busy, or might forget. I won't relax until I see that the samples have been received by the lab and entered into the computer. I'll hand-carry the damn things down myself, charge nurse or not. 

So don't feel bad if you screw up. It happens to all of us. The best you can do is try to fix the mistake, recognize where the mistake started--because it's never just one thing; it's always a chain of events that leads to a mistake--and make plans to avoid it next time.