Nothing else makes that noise, save a lone raven with laryngitis, and there aren't any ravens here. With laryngitis or without.
It's been a nice two days off. Latest on the reading list is "Restoration London", by Liza Picard, which details (among other things) the story of a man named Nicholas If-Jesus-Had-Not-Died-For-Thee-Thou-Hadst-Been-Damned* Barbon, son of Praise-God Barebones. No kidding.
And that thing about the four-and-twenty blackbirds baked in a pie, that all fly out and frighten the king? That was apparently a common joke in the Restoration period. A pie crust was blind-baked (that is, baked empty), the birds inserted in the bottom, alive, the top stuck on, and then the dish brought to the table. When the guest of honor whacked off a piece of top crust, out flew the birds to general merriment. Those Restoration Londoners sure knew how to have fun, huh?
*My sister's comment: "I want a name that has the correct use of subjunctive case!!"
Insomnia project: The Nurse's Survival Kit, Revised and Updated.
1. Good shoes. I don't know how many times I have to say this. Good, heavy, LEATHER shoes with closed toes. And don't buy backless clogs unless you've proven in the past you can run in them.
Dansko, purveyors of dangerous Professional clogs, also makes a sort that are much more sane (with a wider heel base). They're called Dansko@Work.
2. A little tube of Lamisil, for when the skin between your toes begins to crack. This will happen, no matter how careful you are with cotton socks.
3. A little jar of Vicks Vapo-Rub. Good for achy feet, good for smearing under your nose or in your mask before that nasty dressing change. Trust me on this one; you don't want to be without it.
4. Good hand cream. Not that Corn Husker's crap; *good* hand cream. Like ShiKai or Burt's Bees or even Neutrogena. Use it every night when you get home.
5. Belgian ale. I strongly recommend Orval.
Tomorrow, a discussion: Does being in management automatically decimate your IQ?
Monday, January 31, 2005
Wednesday, January 26, 2005
The shutters come down.
Remember the patient I talked about with possible metastatic breast cancer to the brain?
Well, it might be breast cancer. It might be something else. Uncharacteristically for our facility, pathology is taking a long time with this one--reviewing slides and frozen specimens, sending bits of them out to different labs--in an attempt to figure out just what the hell is going on and how to treat it.
Meanwhile, the patient's lost quite a lot of weight and is still unable to swallow. She had a G tube (a tube that runs through the skin into the stomach) placed the other day for supplemental feedings, but she's been so nauseated that she hasn't been able to tolerate them. Her voice is almost gone--dysphonic and scratchy, so she talks in a whisper. She has pneumonia in one lung, since everything she tries to swallow heads down the wrong tube.
I've seen patients with metastatic brain cancer or even gliomas live for a couple of years after diagnosis, enjoying a fairly good to excellent quality of life. This is not going to be one of those patients.
When the doc found the lump in her breast--two months after a clean breast exam during her annual physical--the first thing the patient said was "it's gone to my brain." At that, the shutters came down.
You can tell when it happens. It's not necessarily that the person turns their head away or refuses to make eye contact or participate in care any longer. Sometimes they seem all right at first, and it's only after talking to them for several minutes or interacting with them through a shift that you notice something's wrong.
It's not depression. It's the decision to die. Or maybe it's the decision that nothing that you or the doctors or they themselves do will make the slightest difference. Either way, their eyes get shuttered. You watch them slog through day after day without hope or interest or the slightest bit of pleasure.
In this case, it's pissing me off royally.
This woman has (of course) a loving partner, a good career, dozens of caring friends, a *good* life. I say "of course" because it's always the people with everything going for 'em that get the worst prognoses.
I'd like to light a fire under her ass and get her to fight. Just a little. I can see that she's tired, that she isn't feeling well...but the total unwillingness to even entertain hope has got me peevish.
Nurses and doctors live on hope. We're the kings and queens of denial, when you come right down to it. All the treatments that we order and perform, all the surgeries, are based on the knowledge that, statistically, this thing has worked to solve that problem, and we hope it will on you, too.
When somebody just plain gives up, we tend to take it as a personal affront. It's a defeat of sorts. We spend our days fighting against death and disease and all that noble b.s., and we assume that the people we're working with and working for have some interest in the outcome. When that person doesn't, it's hard to understand.
Hoping is hard. Slogging through is harder.
For the next two days I'll be thinking about this woman, about her dogs and cats and other family. I'll be wondering if she'll be there when I get back and if she is, what fire I can kindle under her hopeless butt.
Queen of Denial, that's me. Sometimes you win, sometimes you lose...and in this business, we tend to lose badly and take it hard.
Well, it might be breast cancer. It might be something else. Uncharacteristically for our facility, pathology is taking a long time with this one--reviewing slides and frozen specimens, sending bits of them out to different labs--in an attempt to figure out just what the hell is going on and how to treat it.
Meanwhile, the patient's lost quite a lot of weight and is still unable to swallow. She had a G tube (a tube that runs through the skin into the stomach) placed the other day for supplemental feedings, but she's been so nauseated that she hasn't been able to tolerate them. Her voice is almost gone--dysphonic and scratchy, so she talks in a whisper. She has pneumonia in one lung, since everything she tries to swallow heads down the wrong tube.
I've seen patients with metastatic brain cancer or even gliomas live for a couple of years after diagnosis, enjoying a fairly good to excellent quality of life. This is not going to be one of those patients.
When the doc found the lump in her breast--two months after a clean breast exam during her annual physical--the first thing the patient said was "it's gone to my brain." At that, the shutters came down.
You can tell when it happens. It's not necessarily that the person turns their head away or refuses to make eye contact or participate in care any longer. Sometimes they seem all right at first, and it's only after talking to them for several minutes or interacting with them through a shift that you notice something's wrong.
It's not depression. It's the decision to die. Or maybe it's the decision that nothing that you or the doctors or they themselves do will make the slightest difference. Either way, their eyes get shuttered. You watch them slog through day after day without hope or interest or the slightest bit of pleasure.
In this case, it's pissing me off royally.
This woman has (of course) a loving partner, a good career, dozens of caring friends, a *good* life. I say "of course" because it's always the people with everything going for 'em that get the worst prognoses.
I'd like to light a fire under her ass and get her to fight. Just a little. I can see that she's tired, that she isn't feeling well...but the total unwillingness to even entertain hope has got me peevish.
Nurses and doctors live on hope. We're the kings and queens of denial, when you come right down to it. All the treatments that we order and perform, all the surgeries, are based on the knowledge that, statistically, this thing has worked to solve that problem, and we hope it will on you, too.
When somebody just plain gives up, we tend to take it as a personal affront. It's a defeat of sorts. We spend our days fighting against death and disease and all that noble b.s., and we assume that the people we're working with and working for have some interest in the outcome. When that person doesn't, it's hard to understand.
Hoping is hard. Slogging through is harder.
For the next two days I'll be thinking about this woman, about her dogs and cats and other family. I'll be wondering if she'll be there when I get back and if she is, what fire I can kindle under her hopeless butt.
Queen of Denial, that's me. Sometimes you win, sometimes you lose...and in this business, we tend to lose badly and take it hard.
Sunday, January 16, 2005
You, too, can join the crew...
Tippecanoe and Nixon, too/Back with Barry's/Not with Lyndon, Ike, or Harry's/Back with Barry's Boys!
(Thanks to the Chad Mitchell Trio)
You are a Folkie. Good for you.
What kind of Sixties Person are you?
brought to you by Quizilla
On to the topical stuff:
Steroids, or, How To Have Fun With Potentially Only Minimal Bodily Damage
Steroids are versatile things. There are several different sorts that we medical types use all the time, for all different purposes.
Generally, corticosteroids (as opposed to the other sort, that build muscle and make you kinda grumpy) relieve inflammation and swelling, act as immunosuppressants, and can be used as diagnostic aids for things like Cushing's syndrome (where your body produces too much cortisol, a naturally-occuring steroid).
That's why I, who have the flu, am taking a prednisolone taper (a Medrol Dosepak). Even though prednisolone has immunosuppressive qualities, those are outweighed (at this dosage) by the anti-inflammatory effects. Meaning, in short, that I'm no longer walking around whimpering because my muscles and joints hurt so much.
It's also why I'm up at 3:37 a.m., typing on the computer, but more about that in a second.
In neurosurgical patients who've had bits of their brains removed, the usual starting dose of dexamethasone (Decadron) is four milligrams every six hours. Sometimes we'll go higher, sometimes lower, depending both on the patient and on the bits of brain removed. After a couple of days of that, we'll taper. It's amazing what that amount of anti-inflammatory can do; I've seen patients who weren't able to swallow improve markedly after 24 hours on Decadron.
You see a lot of steroids used in treatment of asthma and allergies, as well. Advair inhaler? Steroid. Big nasty rash I got those months ago? Treated with steroids. Certain types of arthritis can be treated with 'em as well.
Which brings me to the up-at-three-am-part.
There's a nifty little condition called "steroid hypomania". What happens in a person who's taken largeish doses of steroids (say 60 milligrams of prednisone a day) for a time is this: something flips over in the brain that makes them manic. Not leap-out-a-window, I'm king of the world manic, but pretty manic nonetheless. They get up early, the buzz around like bees all day, they tend to have insomnia.
Strangely enough, a milder version of that side effect happens in almost everybody I've seen who takes steroids. The other, nastier side effects like steroid-induced diabetes or weight gain or bloating tend to take a while, but push four milligrams of Decadron into somebody's IV and you can almost guarantee they'll be up at one a.m. humming old Madonna songs.
Which is why I'm blogging this early, when by all rights I should be lying in bed feeling as though I've been hit by a truck. A combination of steroids and aspirin has brought down my fever and taken away my aches and pains, and the steroids have done their magical work and made me peppy at 3 a.m.
This side effect will be gone by Wednesday, when my taper will have worked from 24 mg (yesterday's dosage, humming Madonna songs) to 12 mg.
Why do we taper? Ah, this is a good one. When you take steroids, even for a short period of time, your body gets lazy. Note that laziness is an evolutionary advantage: it keeps you from having to expend energy on things when that energy could better be used to reproduce or just hang out. Anyhow, expose the human body to steroids and it slows down production of its own steroids. Cut off the steroids abruptly and the body gets all grumpy--the steroid-producing bits act as though they've been shot with a rubber band.
So as you cut the dosage gradually, it's giving your hypothalamus etc. time to ramp up again.
And it gives your right temporal lobe a break from rerunning all those mid-Eighties MTV hits, too.
(Thanks to the Chad Mitchell Trio)
You are a Folkie. Good for you.
What kind of Sixties Person are you?
brought to you by Quizilla
On to the topical stuff:
Steroids, or, How To Have Fun With Potentially Only Minimal Bodily Damage
Steroids are versatile things. There are several different sorts that we medical types use all the time, for all different purposes.
Generally, corticosteroids (as opposed to the other sort, that build muscle and make you kinda grumpy) relieve inflammation and swelling, act as immunosuppressants, and can be used as diagnostic aids for things like Cushing's syndrome (where your body produces too much cortisol, a naturally-occuring steroid).
That's why I, who have the flu, am taking a prednisolone taper (a Medrol Dosepak). Even though prednisolone has immunosuppressive qualities, those are outweighed (at this dosage) by the anti-inflammatory effects. Meaning, in short, that I'm no longer walking around whimpering because my muscles and joints hurt so much.
It's also why I'm up at 3:37 a.m., typing on the computer, but more about that in a second.
In neurosurgical patients who've had bits of their brains removed, the usual starting dose of dexamethasone (Decadron) is four milligrams every six hours. Sometimes we'll go higher, sometimes lower, depending both on the patient and on the bits of brain removed. After a couple of days of that, we'll taper. It's amazing what that amount of anti-inflammatory can do; I've seen patients who weren't able to swallow improve markedly after 24 hours on Decadron.
You see a lot of steroids used in treatment of asthma and allergies, as well. Advair inhaler? Steroid. Big nasty rash I got those months ago? Treated with steroids. Certain types of arthritis can be treated with 'em as well.
Which brings me to the up-at-three-am-part.
There's a nifty little condition called "steroid hypomania". What happens in a person who's taken largeish doses of steroids (say 60 milligrams of prednisone a day) for a time is this: something flips over in the brain that makes them manic. Not leap-out-a-window, I'm king of the world manic, but pretty manic nonetheless. They get up early, the buzz around like bees all day, they tend to have insomnia.
Strangely enough, a milder version of that side effect happens in almost everybody I've seen who takes steroids. The other, nastier side effects like steroid-induced diabetes or weight gain or bloating tend to take a while, but push four milligrams of Decadron into somebody's IV and you can almost guarantee they'll be up at one a.m. humming old Madonna songs.
Which is why I'm blogging this early, when by all rights I should be lying in bed feeling as though I've been hit by a truck. A combination of steroids and aspirin has brought down my fever and taken away my aches and pains, and the steroids have done their magical work and made me peppy at 3 a.m.
This side effect will be gone by Wednesday, when my taper will have worked from 24 mg (yesterday's dosage, humming Madonna songs) to 12 mg.
Why do we taper? Ah, this is a good one. When you take steroids, even for a short period of time, your body gets lazy. Note that laziness is an evolutionary advantage: it keeps you from having to expend energy on things when that energy could better be used to reproduce or just hang out. Anyhow, expose the human body to steroids and it slows down production of its own steroids. Cut off the steroids abruptly and the body gets all grumpy--the steroid-producing bits act as though they've been shot with a rubber band.
So as you cut the dosage gradually, it's giving your hypothalamus etc. time to ramp up again.
And it gives your right temporal lobe a break from rerunning all those mid-Eighties MTV hits, too.
Saturday, January 15, 2005
Fascinating, Doctor.
I have the flu.
The real, live, honest-to-God flu. The sort that gets you a prescription for Tamiflu and a little mask to wear out of the minor emergency clinic. The sort that lets you know it has you the moment you wake up in the morning and start to move--or start to *try* to move.
It surprises me not at all that people die from this. I was wanting to quite enthusiastically while in the doctor's office. When the nurse practitioner walked in, I had just burst into tears, I felt so incredibly bad. She was very kind and swabbed my throat, gave me a Sprite, and sent me on my way.
Two aspirin, a Tamiflu, some toast and guaifenesin and a nap later, I feel almost human. What gets me is that this is apparently one of the mild strains that showed up too late, or something, to be included in the flu shot this year. I'm glad I didn't get a *bad* case.
Please disinfect your computer now.
The real, live, honest-to-God flu. The sort that gets you a prescription for Tamiflu and a little mask to wear out of the minor emergency clinic. The sort that lets you know it has you the moment you wake up in the morning and start to move--or start to *try* to move.
It surprises me not at all that people die from this. I was wanting to quite enthusiastically while in the doctor's office. When the nurse practitioner walked in, I had just burst into tears, I felt so incredibly bad. She was very kind and swabbed my throat, gave me a Sprite, and sent me on my way.
Two aspirin, a Tamiflu, some toast and guaifenesin and a nap later, I feel almost human. What gets me is that this is apparently one of the mild strains that showed up too late, or something, to be included in the flu shot this year. I'm glad I didn't get a *bad* case.
Please disinfect your computer now.
Friday, January 14, 2005
A PSA, of sorts
This is a handy-dandy link for everybody who's currently asking themselves the question "Is it a cold, or is it the flu?"
Of course, the symptoms described here might not apply if you've had a flu shot, or if you actually have a sinus infection, or if you've just got some sort of gark that nobody's bothered to catalogue.
My current list of symptoms range from the nasty to the really sort of cool. The nasty include a moderate fever (100.5 F), a hacking cough that's soothed only by ice cream and some leftover Tessalon Perles (bad nurse, keeping Rx meds around! Bad nurse! No donut!), and general body aches, headache, and malaise. The kinda cool symptoms are the hallucinations out of the corners of my eyes (is that really a binturong on my couch?) and a voice that rivals James Earl Jones's. I'm walking around saying "I find your lack of faith...disturbing" a lot.
The fact that I sound like Darth Vader, complete with breathing, almost makes up for the small furry things that keep darting around at the edge of my vision. Almost.
At least there's plenty of bad TV on, and nice guys down at the Quick-E-Mart who say things like "Helllooooo, dear! My, my! You look not so good today! And how are things?" as they sell me NyQuil.
Of course, the symptoms described here might not apply if you've had a flu shot, or if you actually have a sinus infection, or if you've just got some sort of gark that nobody's bothered to catalogue.
My current list of symptoms range from the nasty to the really sort of cool. The nasty include a moderate fever (100.5 F), a hacking cough that's soothed only by ice cream and some leftover Tessalon Perles (bad nurse, keeping Rx meds around! Bad nurse! No donut!), and general body aches, headache, and malaise. The kinda cool symptoms are the hallucinations out of the corners of my eyes (is that really a binturong on my couch?) and a voice that rivals James Earl Jones's. I'm walking around saying "I find your lack of faith...disturbing" a lot.
The fact that I sound like Darth Vader, complete with breathing, almost makes up for the small furry things that keep darting around at the edge of my vision. Almost.
At least there's plenty of bad TV on, and nice guys down at the Quick-E-Mart who say things like "Helllooooo, dear! My, my! You look not so good today! And how are things?" as they sell me NyQuil.
Thursday, January 13, 2005
This is why work-hour limits are a good idea.
I worked a sixteen-hour day--or what would've been one, had I not fallen over after the fifteenth hour--the other day. We were short-staffed and overrun with complex patients, so I stayed on for the first three hours of the night shift.
And gosh, am I ever tired. Tired, and running a low-grade fever, and with the sort of general achiness and coldness that makes you feel nasty. Not nasty enough to take medicine that might cause sleepiness, dizziness, sleeplessness, seizures, spontaneous amputation of your head, or palpitations, but nasty just the same. It must've been the schedule disruption that laid me open to this bug.
I got to thinking at about 2130 (9:30 pm for the civilians) that I'd been up since 0420. I'd commuted 45 minutes in the morning and had at least that long to go home. I'd been running my ass off all day long with five patients with fairly interesting and complex problems. My last admission needed transfusions of clotting factors, the close monitoring that goes with that, and every-two-hour pulse checks on one leg. And I was exhausted.
I was so exhausted that I forgot which medications are routinely kept in our lockup. I fumble-fingered equipment and misread orders. I stared with incomprehension at a ringing phone and cursed when my beeper went off. When I did finally get home that night, about 11:30 pm, I fell straight into bed and slept for ten hours.
Which makes me wonder how the residents do it. In the past there were no limits to how long residents could work in a week. It wasn't uncommon to hear tales of 20-hour days, week after week, with a brief break or letdown in the summertime or when a resident switched to a less-demanding schedule for a bit. Now, technically, residents are limited to 80-hour work-weeks.
Some of the older attendings are grumpy about this. They say that it makes residents soft, that they never learn how things Really Are in the Medical World. For the most part, our residents--especially the ones in orthopaedics and neurosurgery--are still tired enough to occasionally sleep straight through constant paging in the call room. I've not heard them celebrating the shorter work week. I have the distinct impression that a number of 'em just keep on working, technically breaking the law, when they're supposed to be off the clock.
I still think it's a good idea to limit the amount of time somebody can or should spend taking care of sick people. For myself, I get idiotic after about fourteen hours straight, and I'm not even incising people's bellies. I shudder to think what an underslept neurosurgeon could do.
For another thing, you get emotionally exhausted as a caregiver after a certain amount of time. Most patients aren't going to confide in their doctors the way they do in their nurses, and most doctors don't have to spend twelve hours answering call bells, but the point remains: If you're caring for people, you have a responsibility to them that's gonna weigh more heavily on you during Hour 14 than it did during Hour 1. And the more Hour 14s you have under your belt, the harder it is to be responsive to another person's needs.
And finally, if you're going to be a decent caregiver, whether it's as an MD or RN or LPN or whatever, it helps to have a life. Nobody wants a robot to take care of them. Even if you can't switch easily from discussing sports to discussing opera (depending on the patient), it's nice for the patients to get the sense that you don't spend *all* your time up to your elbows in other people's guts. Gives 'em confidence.
I'm going back to bed. I'm going to wonder as I fall asleep how on earth those residents do it. And I'm going to be thankful--*very* thankful--that I can punch out at the end of twelve or fourteen or sixteen hours and go home, leaving my beeper on the desk.
And gosh, am I ever tired. Tired, and running a low-grade fever, and with the sort of general achiness and coldness that makes you feel nasty. Not nasty enough to take medicine that might cause sleepiness, dizziness, sleeplessness, seizures, spontaneous amputation of your head, or palpitations, but nasty just the same. It must've been the schedule disruption that laid me open to this bug.
I got to thinking at about 2130 (9:30 pm for the civilians) that I'd been up since 0420. I'd commuted 45 minutes in the morning and had at least that long to go home. I'd been running my ass off all day long with five patients with fairly interesting and complex problems. My last admission needed transfusions of clotting factors, the close monitoring that goes with that, and every-two-hour pulse checks on one leg. And I was exhausted.
I was so exhausted that I forgot which medications are routinely kept in our lockup. I fumble-fingered equipment and misread orders. I stared with incomprehension at a ringing phone and cursed when my beeper went off. When I did finally get home that night, about 11:30 pm, I fell straight into bed and slept for ten hours.
Which makes me wonder how the residents do it. In the past there were no limits to how long residents could work in a week. It wasn't uncommon to hear tales of 20-hour days, week after week, with a brief break or letdown in the summertime or when a resident switched to a less-demanding schedule for a bit. Now, technically, residents are limited to 80-hour work-weeks.
Some of the older attendings are grumpy about this. They say that it makes residents soft, that they never learn how things Really Are in the Medical World. For the most part, our residents--especially the ones in orthopaedics and neurosurgery--are still tired enough to occasionally sleep straight through constant paging in the call room. I've not heard them celebrating the shorter work week. I have the distinct impression that a number of 'em just keep on working, technically breaking the law, when they're supposed to be off the clock.
I still think it's a good idea to limit the amount of time somebody can or should spend taking care of sick people. For myself, I get idiotic after about fourteen hours straight, and I'm not even incising people's bellies. I shudder to think what an underslept neurosurgeon could do.
For another thing, you get emotionally exhausted as a caregiver after a certain amount of time. Most patients aren't going to confide in their doctors the way they do in their nurses, and most doctors don't have to spend twelve hours answering call bells, but the point remains: If you're caring for people, you have a responsibility to them that's gonna weigh more heavily on you during Hour 14 than it did during Hour 1. And the more Hour 14s you have under your belt, the harder it is to be responsive to another person's needs.
And finally, if you're going to be a decent caregiver, whether it's as an MD or RN or LPN or whatever, it helps to have a life. Nobody wants a robot to take care of them. Even if you can't switch easily from discussing sports to discussing opera (depending on the patient), it's nice for the patients to get the sense that you don't spend *all* your time up to your elbows in other people's guts. Gives 'em confidence.
I'm going back to bed. I'm going to wonder as I fall asleep how on earth those residents do it. And I'm going to be thankful--*very* thankful--that I can punch out at the end of twelve or fourteen or sixteen hours and go home, leaving my beeper on the desk.
Friday, January 07, 2005
First Full Week Back At Work
Holy. Mary. Mother. Of. God.
I was off a lot--a LOT--during the holidays. So much so that the week between Christmas and New Year's, and the weekend after New Year's, was spent lying around in bed, reading mystery novels, eating good South American food, and generally Hanging Out.
In other words, mama lost her groove.
Wednesday kicked my ass. Thursday kicked several asses. Today kicked our collective ass, then pasted its remains to the wall.
For those of you versed in hospitalese, we have a floor of 28 beds. We started with 18 patients, sent five home, and got sixteen admits. I'm not entirely sure where we put that last extra patient; there were apparently fistfights going on in admissions over our beds.
My day was crazy enough that I'm sitting here typing, eating slabs of cheese and Fritos, drinking a beer, and wishing desperately that I'd caught the hang of smoking as a teenager.
My first patient came from the rehabilitation floor. We'd sent her there two weeks ago. Night before last, the nurse had given her enough oral morphine concentrate for pain that she'd become nonresponsive and Narcan (a drug used to reverse the effects of narcotics) wasn't enough to bring her out of her stupor. She also had a temperature of 102 and pus leaking from her scalp incision.
No, not leaking. Oozing. Ooking. Yarking me out at 0700.
Anyway. She had a sodium of 126 (135-145 is normal), so off she went to ICU. We can't replete sodium with a high-salt intravenous solution on the floor; we have to do it in ICU. She was out by 0800.
Second patient is 42 with metastatic adrenal cancer. His prognosis is grim, to put it nicely. His pupils were two different sizes when I walked in, but the rest of his exam was okay, so we put it down to the morphine he'd been getting for pain. Luckily, we were right.
Third patient is 43 with what looks to be metastatic breast cancer to the brain.
Fourth patient is so manic I nearly killed him. Who on earth has myasthenia gravis and still files paperwork all day?
Fifth patient is a long-term IV drug abuser; smack and crank are drugs of choice. Guess who wants her two milligrams of morphine every hour?
We, as a floor, pride ourselves on getting out on time every night. It's rare that somebody has to stay to chart past the end of the shift. I was the first nurse out of there, having had one very early and one very late admit, and I got out at 7:30 pm. Everyone else is probably still there.
Best moment of the day: A surgery resident of the unusually arrogant type keeps answering the phone, then hanging up on the person when he finds that it's not the person he wants to speak to.....
Nurse Jo: "I need you not to hang up on my consults."
Resident: "Well, I paged *my* consult to this phone; what do you want me to do?"
Nurse Jo: "Let me answer the phone. And keep your paws off our snack foods."
I was off a lot--a LOT--during the holidays. So much so that the week between Christmas and New Year's, and the weekend after New Year's, was spent lying around in bed, reading mystery novels, eating good South American food, and generally Hanging Out.
In other words, mama lost her groove.
Wednesday kicked my ass. Thursday kicked several asses. Today kicked our collective ass, then pasted its remains to the wall.
For those of you versed in hospitalese, we have a floor of 28 beds. We started with 18 patients, sent five home, and got sixteen admits. I'm not entirely sure where we put that last extra patient; there were apparently fistfights going on in admissions over our beds.
My day was crazy enough that I'm sitting here typing, eating slabs of cheese and Fritos, drinking a beer, and wishing desperately that I'd caught the hang of smoking as a teenager.
My first patient came from the rehabilitation floor. We'd sent her there two weeks ago. Night before last, the nurse had given her enough oral morphine concentrate for pain that she'd become nonresponsive and Narcan (a drug used to reverse the effects of narcotics) wasn't enough to bring her out of her stupor. She also had a temperature of 102 and pus leaking from her scalp incision.
No, not leaking. Oozing. Ooking. Yarking me out at 0700.
Anyway. She had a sodium of 126 (135-145 is normal), so off she went to ICU. We can't replete sodium with a high-salt intravenous solution on the floor; we have to do it in ICU. She was out by 0800.
Second patient is 42 with metastatic adrenal cancer. His prognosis is grim, to put it nicely. His pupils were two different sizes when I walked in, but the rest of his exam was okay, so we put it down to the morphine he'd been getting for pain. Luckily, we were right.
Third patient is 43 with what looks to be metastatic breast cancer to the brain.
Fourth patient is so manic I nearly killed him. Who on earth has myasthenia gravis and still files paperwork all day?
Fifth patient is a long-term IV drug abuser; smack and crank are drugs of choice. Guess who wants her two milligrams of morphine every hour?
We, as a floor, pride ourselves on getting out on time every night. It's rare that somebody has to stay to chart past the end of the shift. I was the first nurse out of there, having had one very early and one very late admit, and I got out at 7:30 pm. Everyone else is probably still there.
Best moment of the day: A surgery resident of the unusually arrogant type keeps answering the phone, then hanging up on the person when he finds that it's not the person he wants to speak to.....
Nurse Jo: "I need you not to hang up on my consults."
Resident: "Well, I paged *my* consult to this phone; what do you want me to do?"
Nurse Jo: "Let me answer the phone. And keep your paws off our snack foods."
Monday, January 03, 2005
Silly quiz of the day, since I am off work:
Which Extremity of the World Are You?
From the towering colossi at Rum and Monkey.
I'm apparently somewhere in Libya.
Saturday, December 25, 2004
Happy Christmas!
What on earth are you doing here? Go drink some eggnog, or something.
Best wishes for a peaceful and happy Christmas.
Best wishes for a peaceful and happy Christmas.
Thursday, December 23, 2004
Advancing the profession
I had a conversation about Advancing The Profession two days ago with a friend and colleague at work. Advancing The Profession is, for those of you who aren't nurses, a Big Thing in nursing circles. Nurses who bother to answer surveys report dissatisfaction with their careers, frustration with their practice limitations and paperwork, and anger at how they're perceived and treated by both the public and the other professionals they work with.
There are as many ideas for improvement as there are problems. Many nursing professionals want to change scope of or requirements for practice. Still others want to educate the public. Some want to raise the consciousness of those other professionals with whom nurses work.
Raising Conciousness was the focus of my colleague's and my conversation. I had spent a good part of the morning cleaning up the mess that a group of lazy, ignorant physicians had left and I was frustrated. Being sniped at by everybody and his dog is part of being a nurse, as is cleaning up loose ends that others (usually "too busy" residents) leave lying...but it gets old.
My colleague, who works ICU on the weekends and is an educator during the week, suggested that I devote a little time to Raising The Consciousness of the physicians I'd cleaned up after. And even though it was a good suggestion, I couldn't take it to heart.
Why? Because I was tired. I can see where conciousness-raising would be a brilliant idea: take a resident who's disrespectful aside and talk to him calmly about professionalism and hope for a change. But most of the time, we nurses are so frazzled, we simply don't have the energy to devote to educating the odd Neanderthal who comes in with a medical degree.
I'm lucky on a number of points. The floor where I work is well-staffed. The doctors are, for the most part, good colleagues. My specialty is such that I don't get a lot of jokes or flack about wearing short skirts and a cap. (Say "I'm in neurology" to even the most uncivilized bar patron and they back off.)
But still. Why is it *my* responsibility to educate/lecture/come down on like the crack of Doom somebody who just doesn't get it? If I have the time and the inclination, I will. Otherwise, watch out: if you're an attending physician who hasn't learned to be a decent human being by this time, I am not going to educate you. I'm gonna push back as hard as you push instead.
A group of interns made a video in our nurses' station about how to deal with sexual harassment. It wasn't focused on how to handle the nosy patient if you're a young female doctor, or how to deal with the predatory professor that occasionally crops up. It was on how to deal with a (female) predatory nurse if you're a (male) doctor.
When we (female) nurses all stopped laughing and wiped our eyes, we got into a serious discussion with the instructor of the group. Why, we asked, were the students not being taught lessons that would serve them in good stead? Sexual harassment is covered in our medical school. Being professional and working on a team is not. How not to yell at somebody simply because they're following the rules is not. I'm not implying here that sexual harassment is a chimera or overstated; it's not. What I'm saying is that the curriculum at our facility pays far too much attention to the one problem--often to the exclusion of the other.
I'm a feminist and childfree and a nurse; raising consciousness is not unfamiliar to me. What's unfamiliar is the unwillingness of other professionals with whom I work to police their own. It's left entirely to us to educate/train/police the people who technically are our superiors. At the same time, we're expected to provide good care for sick people and their families, act as gatekeepers and coordinators of care, and keep a smile on.
I once had to report a resident to his attending for being a jerk. I heard the tail end of the lecture the attending gave the resident. Just before Attending turned Resident loose to go back to work, he said, "...and don't let their hysteria get to you, okay? Most of them just aren't that tough." (Enter Crack of Doom Nurse hard on the heels of that statement.) Point being that I'm expected to Educate and Enlighten this person, but his boss will undermine me, then blame nurses for the lack of respect that his students show them.
Honestly, I have no solution for this particular problem. All I can do is keep practicing as professionally as I know how and deal with trouble when it happens. I just hope I'm not completely burned out by the time I retire.
There are as many ideas for improvement as there are problems. Many nursing professionals want to change scope of or requirements for practice. Still others want to educate the public. Some want to raise the consciousness of those other professionals with whom nurses work.
Raising Conciousness was the focus of my colleague's and my conversation. I had spent a good part of the morning cleaning up the mess that a group of lazy, ignorant physicians had left and I was frustrated. Being sniped at by everybody and his dog is part of being a nurse, as is cleaning up loose ends that others (usually "too busy" residents) leave lying...but it gets old.
My colleague, who works ICU on the weekends and is an educator during the week, suggested that I devote a little time to Raising The Consciousness of the physicians I'd cleaned up after. And even though it was a good suggestion, I couldn't take it to heart.
Why? Because I was tired. I can see where conciousness-raising would be a brilliant idea: take a resident who's disrespectful aside and talk to him calmly about professionalism and hope for a change. But most of the time, we nurses are so frazzled, we simply don't have the energy to devote to educating the odd Neanderthal who comes in with a medical degree.
I'm lucky on a number of points. The floor where I work is well-staffed. The doctors are, for the most part, good colleagues. My specialty is such that I don't get a lot of jokes or flack about wearing short skirts and a cap. (Say "I'm in neurology" to even the most uncivilized bar patron and they back off.)
But still. Why is it *my* responsibility to educate/lecture/come down on like the crack of Doom somebody who just doesn't get it? If I have the time and the inclination, I will. Otherwise, watch out: if you're an attending physician who hasn't learned to be a decent human being by this time, I am not going to educate you. I'm gonna push back as hard as you push instead.
A group of interns made a video in our nurses' station about how to deal with sexual harassment. It wasn't focused on how to handle the nosy patient if you're a young female doctor, or how to deal with the predatory professor that occasionally crops up. It was on how to deal with a (female) predatory nurse if you're a (male) doctor.
When we (female) nurses all stopped laughing and wiped our eyes, we got into a serious discussion with the instructor of the group. Why, we asked, were the students not being taught lessons that would serve them in good stead? Sexual harassment is covered in our medical school. Being professional and working on a team is not. How not to yell at somebody simply because they're following the rules is not. I'm not implying here that sexual harassment is a chimera or overstated; it's not. What I'm saying is that the curriculum at our facility pays far too much attention to the one problem--often to the exclusion of the other.
I'm a feminist and childfree and a nurse; raising consciousness is not unfamiliar to me. What's unfamiliar is the unwillingness of other professionals with whom I work to police their own. It's left entirely to us to educate/train/police the people who technically are our superiors. At the same time, we're expected to provide good care for sick people and their families, act as gatekeepers and coordinators of care, and keep a smile on.
I once had to report a resident to his attending for being a jerk. I heard the tail end of the lecture the attending gave the resident. Just before Attending turned Resident loose to go back to work, he said, "...and don't let their hysteria get to you, okay? Most of them just aren't that tough." (Enter Crack of Doom Nurse hard on the heels of that statement.) Point being that I'm expected to Educate and Enlighten this person, but his boss will undermine me, then blame nurses for the lack of respect that his students show them.
Honestly, I have no solution for this particular problem. All I can do is keep practicing as professionally as I know how and deal with trouble when it happens. I just hope I'm not completely burned out by the time I retire.
Saturday, December 18, 2004
Okay, okay, it's done.
Bidness
Whew. I got a number of new links up. My original idea was to parcel them all out nicely so that Gentle Readers would have some idea of what they were getting into (Medical? Humor? Other?), but not only do my HTML skills suck, I figured at the end of the day that I don't know what I'm getting into at any given moment; why should you?
Update the First
Coworker's Brother has had the last of four surgeries. The docs found the bleed that was giving him trouble, so he'll be medevac'ed to Europe in the next few days.
Update the Second
Troublesome Coworker is rapidly weaving rope.
Update the Third
Hemicorporectomy Guy (and don't feel bad if you've been humming "Eric the Half-A-Bee"; we all have) is doing fine.
End of Updates.
Any nurse can tell you that a number of folks will ask, when told that you're a nurse, how to improve their health, well-being, and general mood. In an attempt to head off those folks at Christmas parties this year, I present:
Nurse Jo's Tips On How To Live A Happy, Healthy Life
1. Don't be mean. That's number one for a reason. If you're mean, you make everyone around you miserable. You'll be lonely and sick and people will think you deserve it. So don't do it. Smile, smile, smile.
Or if you can't, at least fake it.
2. Shut your piehole and move. No great mystery here. The average person eats too much and moves too little. Get or borrow a dog and take it on runs. Play with your kids. Turn off the TV, or at least do crunches during the commercials.
3. Vegetables: the green things at one end of the grocery store. Vegetables are fun. Really. They're interesting. You should eat them occasionally.
4. Relax. There's nothing worth getting *that* upset over.
5. Drink if you like, smoke if you must. Just don't be a self-righteous twerp. See Point Number One. Self-righteous twerpiness goes right along with meanness in shortening your life. I don't care what you do as long as you're a reasonable human being. If your choices are smoke crack or be a twerp, let me get you a lighter.
6. Water. Your body is 70% water, not 70% Diet Coke.
7. Find what you like to do, then do it. This relates both to work and non-work situations. If you passion is basket-weaving, then by all means, weave baskets. The point is to have at least one thing in which you can lose yourself on a weekly if not daily basis. Which brings me to:
8. Get out of your own head. It ain't all about you, so find something that helps you remember that.
9. Act. Whatever gods are running the Universe don't care what you *think*, they care what you *do*.
10. Recognize that life really *is* that funny and ridiculous.
Whew. I got a number of new links up. My original idea was to parcel them all out nicely so that Gentle Readers would have some idea of what they were getting into (Medical? Humor? Other?), but not only do my HTML skills suck, I figured at the end of the day that I don't know what I'm getting into at any given moment; why should you?
Update the First
Coworker's Brother has had the last of four surgeries. The docs found the bleed that was giving him trouble, so he'll be medevac'ed to Europe in the next few days.
Update the Second
Troublesome Coworker is rapidly weaving rope.
Update the Third
Hemicorporectomy Guy (and don't feel bad if you've been humming "Eric the Half-A-Bee"; we all have) is doing fine.
End of Updates.
Any nurse can tell you that a number of folks will ask, when told that you're a nurse, how to improve their health, well-being, and general mood. In an attempt to head off those folks at Christmas parties this year, I present:
Nurse Jo's Tips On How To Live A Happy, Healthy Life
1. Don't be mean. That's number one for a reason. If you're mean, you make everyone around you miserable. You'll be lonely and sick and people will think you deserve it. So don't do it. Smile, smile, smile.
Or if you can't, at least fake it.
2. Shut your piehole and move. No great mystery here. The average person eats too much and moves too little. Get or borrow a dog and take it on runs. Play with your kids. Turn off the TV, or at least do crunches during the commercials.
3. Vegetables: the green things at one end of the grocery store. Vegetables are fun. Really. They're interesting. You should eat them occasionally.
4. Relax. There's nothing worth getting *that* upset over.
5. Drink if you like, smoke if you must. Just don't be a self-righteous twerp. See Point Number One. Self-righteous twerpiness goes right along with meanness in shortening your life. I don't care what you do as long as you're a reasonable human being. If your choices are smoke crack or be a twerp, let me get you a lighter.
6. Water. Your body is 70% water, not 70% Diet Coke.
7. Find what you like to do, then do it. This relates both to work and non-work situations. If you passion is basket-weaving, then by all means, weave baskets. The point is to have at least one thing in which you can lose yourself on a weekly if not daily basis. Which brings me to:
8. Get out of your own head. It ain't all about you, so find something that helps you remember that.
9. Act. Whatever gods are running the Universe don't care what you *think*, they care what you *do*.
10. Recognize that life really *is* that funny and ridiculous.
Monday, December 13, 2004
Friday, December 10, 2004
Too close to home
A coworker's brother was shot halfway to hell in Fallujah today. (Yesterday? I don't know the time difference.)
His squad was marching down the street when a car bomb was detonated next to them. The guy behind him died, but in doing so, sprayed my coworker's brother with bullets. He (the brother) also has some nasty shrapnel wounds.
Thanks be to the Army medics who got there first. They're still working on him in a field hospital in Iraq, trying to find the internal bleeding that's keeping him in critical condition. After they do, he'll be airlifted to Europe for further surgery.
When the Red Cross called her as she was on her way to work, all the person could tell her was that her brother'd been shot. They had no details. Wouldn't you hate to have that job?
Any prayers on her behalf, on behalf of her brother, and on behalf of her two siblings--also in the Army, also near or in Fallujah--would be gratefully accepted.
Any political emails will be tossed back to the senders so hard that the electrons bounce. I'm too upset by her upset-ness to be rational.
His squad was marching down the street when a car bomb was detonated next to them. The guy behind him died, but in doing so, sprayed my coworker's brother with bullets. He (the brother) also has some nasty shrapnel wounds.
Thanks be to the Army medics who got there first. They're still working on him in a field hospital in Iraq, trying to find the internal bleeding that's keeping him in critical condition. After they do, he'll be airlifted to Europe for further surgery.
When the Red Cross called her as she was on her way to work, all the person could tell her was that her brother'd been shot. They had no details. Wouldn't you hate to have that job?
Any prayers on her behalf, on behalf of her brother, and on behalf of her two siblings--also in the Army, also near or in Fallujah--would be gratefully accepted.
Any political emails will be tossed back to the senders so hard that the electrons bounce. I'm too upset by her upset-ness to be rational.
Wednesday, December 08, 2004
Odds and Ends and Drama
From Correspondent Tim, somewhere out there in the Worldwideinternetwebland, comes this very funny list of do's and don'ts for patients. Tim says "all of these would've come in handy had I known to tell my patients beforehand."
Some generalized advice for patients
Dos
1) ...ask if the large puddle of blood pooling under your disconnected IV is normal.
2) ...ask for help reinserting foley catheters if you pull them out.
3) ...use short chairs instead of tall barstools if you drink too much and have osteoporosis.
4) ...ask for help if you wish to amputate a body part BEFORE you start cutting.
Don'ts
1) ... tell the hospital policeman that you need to go get your gun.
2) ... steal the laptop computer I use to sign out your medications.
3) ... slam the Pleurevac in the door of the cab as you leave AMA.
4) ... barf on the nurse. (the biggie)
*snork*
It finally happened
"It" being Nurse Jo coming down on another nurse like the crack of doom. "Goddammit" was probably an ill-advised thing to say. "Fuck" was certainly unprofessional. The screaming will surely be discussed and embellished in rumor for weeks to come...but the only thing I feel bad about is the fact that I'll have a whopping big meeting with the floor manager on Thursday.
There's something about being a nurse that makes other people think they can yell at you. I got yelled at yesterday seven times before noon--that's more than once an hour if you're keeping track, which I certainly was after Yell Number Three. The reason I was getting yelled at and complained to was the attitude and shoddy people skills of the nurse whose patients I got yesterday morning.
A very nice paraplegic guy was upset because he wasn't given enough in-and-out catheters to use all night. Given that he gets dysreflexic if there's more than about 200 ccs of urine in his bladder, catheters are important. He also didn't get antispasmodic medication (very important for spinal-cord-injury patients; the limbs don't just lie there, they spasm) or pain medication for most of the night. There were other problems too minor to go into here...but they add up.
Another patient's husband was upset about the lack of communication on the nurse's part vis a vis what was happening with his wife. The doctor on the case was upset by her lack of help. The doctors on the consulting team were unhappy that the patient had gotten a large enough dose of sedative to leave her obtunded for hours and still zonked the next afternoon.
And all this came down on me. I ran around for several hours making nice, trying to wake my patient up, and generally picking up the pieces. The nurse who left me with this basket of rabid weasels is a technically excellent nurse. She's the shit when it comes to starting IVs and doing paperwork, but her attitude toward any patient who doesn't sleep peacefully all night sucks.
I'd finally had it. After she'd started complaining once again about how big a pain in her ass the obtunded patient had been, I went into Screaming Harpy Mode and yelled. For about ten seconds, at which time I realized it was pointless. Any nurse who responds to the suggestion that she might've oversedated a patient just a *leeeetle* bit with the words "I have to give what the doctor orders, that's my job" is a nincompoop.
I should've used the word "nincompoop" rather than "idiot". I should've moderated my tone and spoken to her in a calm, professional manner outside of the tension of the report room. I should've taken into account what had happened to her that night to make her personality even more wretched than usual.
I should've ripped her arm off and beaten her to death with it there on the spot.
Addendum: I came home to find a message on my machine from this same nurse, asking me to call her so she could clarify something with me. "If you can't, it's no big deal" she said. So I didn't. It's three a.m. If anybody says word uno to me about my not calling back, I'll point out that I too have been dragged into the 20th century and own a cell phone. Call me on that.
Ooooooohhhh, I am *so* not looking forward to Thursday.
Some generalized advice for patients
Dos
1) ...ask if the large puddle of blood pooling under your disconnected IV is normal.
2) ...ask for help reinserting foley catheters if you pull them out.
3) ...use short chairs instead of tall barstools if you drink too much and have osteoporosis.
4) ...ask for help if you wish to amputate a body part BEFORE you start cutting.
Don'ts
1) ... tell the hospital policeman that you need to go get your gun.
2) ... steal the laptop computer I use to sign out your medications.
3) ... slam the Pleurevac in the door of the cab as you leave AMA.
4) ... barf on the nurse. (the biggie)
*snork*
It finally happened
"It" being Nurse Jo coming down on another nurse like the crack of doom. "Goddammit" was probably an ill-advised thing to say. "Fuck" was certainly unprofessional. The screaming will surely be discussed and embellished in rumor for weeks to come...but the only thing I feel bad about is the fact that I'll have a whopping big meeting with the floor manager on Thursday.
There's something about being a nurse that makes other people think they can yell at you. I got yelled at yesterday seven times before noon--that's more than once an hour if you're keeping track, which I certainly was after Yell Number Three. The reason I was getting yelled at and complained to was the attitude and shoddy people skills of the nurse whose patients I got yesterday morning.
A very nice paraplegic guy was upset because he wasn't given enough in-and-out catheters to use all night. Given that he gets dysreflexic if there's more than about 200 ccs of urine in his bladder, catheters are important. He also didn't get antispasmodic medication (very important for spinal-cord-injury patients; the limbs don't just lie there, they spasm) or pain medication for most of the night. There were other problems too minor to go into here...but they add up.
Another patient's husband was upset about the lack of communication on the nurse's part vis a vis what was happening with his wife. The doctor on the case was upset by her lack of help. The doctors on the consulting team were unhappy that the patient had gotten a large enough dose of sedative to leave her obtunded for hours and still zonked the next afternoon.
And all this came down on me. I ran around for several hours making nice, trying to wake my patient up, and generally picking up the pieces. The nurse who left me with this basket of rabid weasels is a technically excellent nurse. She's the shit when it comes to starting IVs and doing paperwork, but her attitude toward any patient who doesn't sleep peacefully all night sucks.
I'd finally had it. After she'd started complaining once again about how big a pain in her ass the obtunded patient had been, I went into Screaming Harpy Mode and yelled. For about ten seconds, at which time I realized it was pointless. Any nurse who responds to the suggestion that she might've oversedated a patient just a *leeeetle* bit with the words "I have to give what the doctor orders, that's my job" is a nincompoop.
I should've used the word "nincompoop" rather than "idiot". I should've moderated my tone and spoken to her in a calm, professional manner outside of the tension of the report room. I should've taken into account what had happened to her that night to make her personality even more wretched than usual.
I should've ripped her arm off and beaten her to death with it there on the spot.
Addendum: I came home to find a message on my machine from this same nurse, asking me to call her so she could clarify something with me. "If you can't, it's no big deal" she said. So I didn't. It's three a.m. If anybody says word uno to me about my not calling back, I'll point out that I too have been dragged into the 20th century and own a cell phone. Call me on that.
Ooooooohhhh, I am *so* not looking forward to Thursday.
Sunday, December 05, 2004
Saturday, December 04, 2004
All I want for Christmas
The tree is up, the frost is on the goose, the pumpkin is getting fat.
Or something like that. The tree (a nice Fraser fir) is indeed up, all six feet of Seuss-inspired silliness of it. I went to a local Walgetmartorama to look at artificial trees and came away unutterably depressed, so I broke all the apartment complex's rules today with my Fresh Cut Tree! Hooray!
The cat is disturbed by the presence of a tree in the living room, but she'll live.
What I want for Christmas, the non-commercial version:
1. To be listed under "Nursing Staff" on Cut to Cure.
2. To get a submission accepted for Grand Rounds. Note that I haven't actually submitted anything yet, primarily because the people who are listed are, like, geniuses. And I feel like an idiot. A neurologically-focused idiot, but a moe-ron nonetheless.
3. Three or four days off in a row with nobody calling me to see if I want an extra shift, or if I'd be willing to be on call. Everybody's been sick lately, what with induced labors and broken backs and the flu.
4. A comic strip that is as unironic and simply beautiful as the old "Peanuts" was.
5. Six more residents like Dario, Mia, Christos, and Jay. Another attending like Kevin: "I went to the Kellogg School of Management so I could manage cornflakes more effectively." Another surgeon like Duke or Bruce.
6. Failing that, no more like Dr. Chucklehead.
Or something like that. The tree (a nice Fraser fir) is indeed up, all six feet of Seuss-inspired silliness of it. I went to a local Walgetmartorama to look at artificial trees and came away unutterably depressed, so I broke all the apartment complex's rules today with my Fresh Cut Tree! Hooray!
The cat is disturbed by the presence of a tree in the living room, but she'll live.
What I want for Christmas, the non-commercial version:
1. To be listed under "Nursing Staff" on Cut to Cure.
2. To get a submission accepted for Grand Rounds. Note that I haven't actually submitted anything yet, primarily because the people who are listed are, like, geniuses. And I feel like an idiot. A neurologically-focused idiot, but a moe-ron nonetheless.
3. Three or four days off in a row with nobody calling me to see if I want an extra shift, or if I'd be willing to be on call. Everybody's been sick lately, what with induced labors and broken backs and the flu.
4. A comic strip that is as unironic and simply beautiful as the old "Peanuts" was.
5. Six more residents like Dario, Mia, Christos, and Jay. Another attending like Kevin: "I went to the Kellogg School of Management so I could manage cornflakes more effectively." Another surgeon like Duke or Bruce.
6. Failing that, no more like Dr. Chucklehead.
Friday, December 03, 2004
Wired, tired, and done, oh my.
I am finished wrapping Christmas presents. That is, I'm done wrapping the ones I have to mail to my family. I'm not done wrapping the ones I bought for The Boy, nor have I even finished assembling the present for a Secret Pal I have through an online forum. But the majority of Christmas present-wrapping is done, which gives me great pride. Even more than that, none of the presents look as though they've been wrapped by a mentally-deficient orangutan with Tourette's. This is unusual for me.
Yesterday was one of those days that every nurse dreads. Nobody coded; nobody had intractable pain...but nothing happened all day.
Nothing, that is, until about an hour and a half before the shift ended, at which point we got eight admissions. That sort of day will make you crazy: You start out well, get into your groove of planning and assessing and running around, then hit a wall. You sit for eight hours with absolutely nada to do, and then all hell breaks loose in the middle of your nap.
I got home so wired I didn't get to bed until after midnight. That's twenty hours out of twenty-four that I was up. It's no surprise I took a two-hour nap today.
Following is an opinion I sent to a pal via email today, included because I'm too damned lazy to think of anything new to write:
I have a BA in music and sociology (double major) and an ADN myself.
Unless you want to teach, research, or be an NP, don't get an MSN. MSNs
are highly specialized and focus on management (ugh) or specific areas
of practice like oncology or family practice or women's health etc.
MSNs are a waste of time for the average floor nurse (which is what I
am) and not a great idea for anybody who wants to stop at, say,
midlevel management. Even for upper-level management in a hospital or
community health setting, an MBA would be a better choice.
BSNs are fine and dandy, but I think they're overrated by the nursing
establishment. The amount of clinical experience you get with a BSN
compared with an ADN is about the same; the major difference is (again)
in the focus on management and decision-making skills. What the
proponents of BSN over ADN fail to recognize in my experience, though,
is that the majority of people getting ADNs are doing so because
they've either already got a degree or three in something else or
because they're 45 and changing careers. Both of those things reduce
the need for extra courses on prioritization, law, and management. We
been there, done that.
My advice, which costs what it's worth, is this: get the ADN. It'll
come near to killing you if you pick a good program, but you'll get
more knowledge in less time than you would if you did it any other way.
After that, work in a clinical setting of some sort for a year or two.
(Everybody says that and I've become a believer myself; there's just
something about knowing what works in real life versus what the books
say.) After *that*, make a decision on what to do with the rest of your
brain. You might decide that eine kleine floor nurse is what you want
to be, or you might have found some specialty that sparks a need to go
further in school.
A word about specialties: everybody ("everybody" being nursing
professors, nursing consultants, and others who haven't worked in the
field for years) says to work med-surg for a couple of years to "build
your skills" before you specialize. Bullshit, in a word. People coming
into hospitals are so sick now, and have so much going on in terms of
different systemic involvements, that even a specialty is broad enough
in practice to learn things. I deal every day with cardiac involvement,
diabetes, arthritis, women of reproductive age...you name it. And I
work in an environment that I lot of people would consider progressive
care rather than an acute care floor.
That, in long, is my sermon to anybody considering starting a nursing career after doing something else.
Yesterday was one of those days that every nurse dreads. Nobody coded; nobody had intractable pain...but nothing happened all day.
Nothing, that is, until about an hour and a half before the shift ended, at which point we got eight admissions. That sort of day will make you crazy: You start out well, get into your groove of planning and assessing and running around, then hit a wall. You sit for eight hours with absolutely nada to do, and then all hell breaks loose in the middle of your nap.
I got home so wired I didn't get to bed until after midnight. That's twenty hours out of twenty-four that I was up. It's no surprise I took a two-hour nap today.
Following is an opinion I sent to a pal via email today, included because I'm too damned lazy to think of anything new to write:
I have a BA in music and sociology (double major) and an ADN myself.
Unless you want to teach, research, or be an NP, don't get an MSN. MSNs
are highly specialized and focus on management (ugh) or specific areas
of practice like oncology or family practice or women's health etc.
MSNs are a waste of time for the average floor nurse (which is what I
am) and not a great idea for anybody who wants to stop at, say,
midlevel management. Even for upper-level management in a hospital or
community health setting, an MBA would be a better choice.
BSNs are fine and dandy, but I think they're overrated by the nursing
establishment. The amount of clinical experience you get with a BSN
compared with an ADN is about the same; the major difference is (again)
in the focus on management and decision-making skills. What the
proponents of BSN over ADN fail to recognize in my experience, though,
is that the majority of people getting ADNs are doing so because
they've either already got a degree or three in something else or
because they're 45 and changing careers. Both of those things reduce
the need for extra courses on prioritization, law, and management. We
been there, done that.
My advice, which costs what it's worth, is this: get the ADN. It'll
come near to killing you if you pick a good program, but you'll get
more knowledge in less time than you would if you did it any other way.
After that, work in a clinical setting of some sort for a year or two.
(Everybody says that and I've become a believer myself; there's just
something about knowing what works in real life versus what the books
say.) After *that*, make a decision on what to do with the rest of your
brain. You might decide that eine kleine floor nurse is what you want
to be, or you might have found some specialty that sparks a need to go
further in school.
A word about specialties: everybody ("everybody" being nursing
professors, nursing consultants, and others who haven't worked in the
field for years) says to work med-surg for a couple of years to "build
your skills" before you specialize. Bullshit, in a word. People coming
into hospitals are so sick now, and have so much going on in terms of
different systemic involvements, that even a specialty is broad enough
in practice to learn things. I deal every day with cardiac involvement,
diabetes, arthritis, women of reproductive age...you name it. And I
work in an environment that I lot of people would consider progressive
care rather than an acute care floor.
That, in long, is my sermon to anybody considering starting a nursing career after doing something else.
Tuesday, November 30, 2004
Rock/Suck
The occasional Rock/Suck list returns.
Rock:
1. Hamilton-Beach's version of an electric grilling machine. I just made no-added-fat salmon with garlic and pepper in under eight minutes. And mushrooms. And asparagus. Next up, portabello mushrooms. Plus, you can flatten the darned thing out and put on flat grill plates and make pancakes for your sweetie!
2. Glad Corn. For the love of Mike, stay away from this stuff. It's salty, crunchy, a cross between Corn-Nuts and popcorn, and I think they dust it with crack. The cat even ate some while my back was turned. You can find it at any good organic food store, right under the sign that says "I'd Turn Back If I Were You."
3. Land's End flannel sheets. I have a set that Beloved Sister sent after she was done with them, and they're still the softest, warmest things I own. No frays, either, on the hems.
Suck:
1. Garnier Fructis Revitalizing Shampoo. I'm sure it's wonderful for some folks, and gee it smells terrific, but it turns my hair brown. My hair is red.
2. Any generic brand "guacamole-style" dip. Just...don't.
3. Dropping a Christmas present on your feet. Especially if it's a Christmas present your folks sent you. Especially if it's a 19-kilogram (41 lb) folding butcher-block table with a stainless steel frame. Again, just...don't.
Rock:
1. Hamilton-Beach's version of an electric grilling machine. I just made no-added-fat salmon with garlic and pepper in under eight minutes. And mushrooms. And asparagus. Next up, portabello mushrooms. Plus, you can flatten the darned thing out and put on flat grill plates and make pancakes for your sweetie!
2. Glad Corn. For the love of Mike, stay away from this stuff. It's salty, crunchy, a cross between Corn-Nuts and popcorn, and I think they dust it with crack. The cat even ate some while my back was turned. You can find it at any good organic food store, right under the sign that says "I'd Turn Back If I Were You."
3. Land's End flannel sheets. I have a set that Beloved Sister sent after she was done with them, and they're still the softest, warmest things I own. No frays, either, on the hems.
Suck:
1. Garnier Fructis Revitalizing Shampoo. I'm sure it's wonderful for some folks, and gee it smells terrific, but it turns my hair brown. My hair is red.
2. Any generic brand "guacamole-style" dip. Just...don't.
3. Dropping a Christmas present on your feet. Especially if it's a Christmas present your folks sent you. Especially if it's a 19-kilogram (41 lb) folding butcher-block table with a stainless steel frame. Again, just...don't.
What I do when I'm not working.
Truly kickass pasta salad
Normally I hate pasta salad. I don't hate this one. Warning: it will make all vampires in your neighborhood very scarce.
Boil 1/2 pound of pasta, preferably something twisty or round-y or ridged.
While the pasta is cooking to the al dente stage, combine:
3/4 cup olive oil
1/4 cup red balsamic vinegar
2 tablespoons capers
about a teaspoon of anchovy paste
about a teaspoon of black pepper
5 big cloves of garlic
In a blender and whirrrrrr until it's all unlumpy and creamy.
Drain cooked pasta and dump in bowl. Follow with enough of the dressing to coat--you may not need all of it. Let it cool down a bit.
Add:
*1 cucumber, peeled, seeded, and diced
*1 diced red pepper
*2 cans quartered artichoke hearts, torn up with your hands while you giggle
*1 pint of quartered or halved cherry tomatoes--the really sweet sort you have to stop snacking on as you cook
*enough black olives to make you hum under your breath. Kalamatas are good.
*some cheese, cubed. Mozzerella is yummy, though I'm partial to a nice mild Muenster.
You want something that's mostly veggies, with pasta as a filler. Sometimes I add tiny whole broiled mushrooms or chunks of cooked chicken. Sometimes I add bits of ham or salami. Sometimes I don't add anything extra and simply sit on the floor, eating the salad out of the bowl with my big wooden mixing spoon.
Normally I hate pasta salad. I don't hate this one. Warning: it will make all vampires in your neighborhood very scarce.
Boil 1/2 pound of pasta, preferably something twisty or round-y or ridged.
While the pasta is cooking to the al dente stage, combine:
3/4 cup olive oil
1/4 cup red balsamic vinegar
2 tablespoons capers
about a teaspoon of anchovy paste
about a teaspoon of black pepper
5 big cloves of garlic
In a blender and whirrrrrr until it's all unlumpy and creamy.
Drain cooked pasta and dump in bowl. Follow with enough of the dressing to coat--you may not need all of it. Let it cool down a bit.
Add:
*1 cucumber, peeled, seeded, and diced
*1 diced red pepper
*2 cans quartered artichoke hearts, torn up with your hands while you giggle
*1 pint of quartered or halved cherry tomatoes--the really sweet sort you have to stop snacking on as you cook
*enough black olives to make you hum under your breath. Kalamatas are good.
*some cheese, cubed. Mozzerella is yummy, though I'm partial to a nice mild Muenster.
You want something that's mostly veggies, with pasta as a filler. Sometimes I add tiny whole broiled mushrooms or chunks of cooked chicken. Sometimes I add bits of ham or salami. Sometimes I don't add anything extra and simply sit on the floor, eating the salad out of the bowl with my big wooden mixing spoon.
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