Mostly True Stories

Flush it!

2008-05-15T06:48:00.003-04:00

I was helping S admit a patient. The patient's cousin was in the room.

When was the last time you had a bowel movement? I asked the patient.

This morning, she had one this morning, the cousin responded.

Wow, your cousin sure knows a lot about you, I said.

Well, the cousin told me, she forgot to flush it.

Cheezburger Break

2008-05-06T21:18:00.001-04:00

more cat pictures

Cuernavaca Journal: Day 3

2008-04-23T22:25:00.003-04:00

When we get to breakfast this morning, Neil is already at the table. I haven't had a chance to speak to him very much at school, but he is in all of Kenny's classes.

We all greet each other with various levels of Spanish and Kenny and I begin to eat our fruit. Steaming Christmas mugs full of coffee show up in front of each of us. Merry Christmas! Neil tells everyone in Spanish, toasting in our general direction with a Frosty-the-Snowman mug. Chelo laughs and walks back to the kitchen.

Oh Senora.....Neil calls out. I have been wanting the milk, please. Some of Neil's sentence constructions remind me of David Sedaris essays -- especially the one where he goes to the doctor in Paris. I immediately capitalize on Neil's request and pour some milk into my coffee. Chelo goes back into the kitchen.

Oh....SenOOOOra....Neil calls out. I am breakfasting on how many eggs today?

Two, everybody gets two. Would you care for more? Chelo asks him.

No, thank you, this is just fine, but my wife will be wanting to know when I get home.

Over the next few days, Neil will turn out to be a near constant source of comic relief. But both Kenny and I are uncomfortable with the way he treats our hostess. He has been staying with the family exactly one day longer than we have. Listen, he tells us on the way to school, I paved the way for you people. Before I asked, there wasn't even any 1978 margarine for the dry toast!

In class, I start to realize that I am watching the clock. How ridiculous am I? I chose this vacation. I am paying for it. I am HAPPY to be improving my Spanish. Yet, apparently, my amazing capacity for dread trumps all of this. I spend a moment secretly evaluating my classmates. Are they looking forward to the break? To the comida? To after school shopping, touring and beer? I go back to my work and try to be in the moment...and in Spanish. In the Spanish moment. Every once in a while, the merriment from Kenny and Neil's class will interrupt ours. Their teacher, Marilu -- who also teaches one of my classes, has a very charming way of saying super...or super duper. Soooopair doooopair, she says. Also, apparently, Kenny has accidently told the class that he and I ate each other for breakfast instead of we ate breakfast together.

Today, back at Chelo's house, there is a big party. Because it's Wednesday. Every Wednesday, everybody related to Chelo in Cuernavaca eats comida at her house. This explains the 3 dining tables and two kitchens. Chicken mole will be served. I tell Chelo again that Kenny is allergic to nuts -- she tells me that she will have something else available for Kenny. Nuts are not a traditional ingredient in this particular mole recipe (many mole recipes do call for nuts) but she buys the paste already made -- so she can't be 100% sure about a total absence of nuts. The mole is wonderful -- served with crusty bread, iceberg lettuce, beans and salsa as always. Kenny gets a delicious looking chicken milanesa. Our classmate, Chislan, is there because he is staying in the home of Chelo's daughter. Chislan and I talk some in Spanish while Cesar, Chelo's son, corrects us. It turns out he used to teach at a different school -- like 30 yrs ago. That is how he met his American wife -- who teaches at a local Catholic school. Chelo has told me that she had all of her children (either 4, 6 or 7 of them -- I didn't understand the story completely) in this house with no more anesthetic than a cup of chamomile tea. But, in order to do this, you will need very strong tea, she tells me.

After comida, we hop a taxi to Las Mananitas -- an unbelievably expensive and beautiful hotel and restaurant. We just plan to have drinks in the garden. The garden is patrolled by a variety of peacocks and other tropical birds. It is really a beautiful place. I have a Negra Modelo with lime and snack on the complimentary tray of spicy peanuts, pepitas and potato chips with sour cream dip while Kenny has a $12 flan with a double expresso. The waiters are gracious and act as if we are very important even though we are in our sweaty school clothes and obviously not eating dinner. Mexican people, in general, are just very courteous. They are polite to each other and they (for the most part) treat visitors to their country with painstaking hospitality.

After our treats, we walk a couple of blocks, then take a taxi back to our neighborhood. While we are downtown -- in el centro -- we see the Palace of Cortez, which is now a museum, but we don't go in -- it's too late. Back in our own neighborhood, we walk by the taco family. Tacos? They ask us. Tomorrow we tell them. Tomorrow.

It is now day three for both of us without a bowel movement.

Cuernavaca: Day 2

2008-04-22T22:33:00.003-04:00

Nobody in Cuernavaca has a front yard that you can see. Houses are built, in some form of fashion, all the way out to the sidewalk. Last night, as we were walking back to Chelo's house after our beers, we walked by an open garage. A huge grill had been pulled out to the sidewalk. Several youngish Mexicans are gathered around the grill and busy in the garage. Beef is being grilled, tortillas are being heated, smells (oh, the most wonderful smells) are being created. Tacos? They ask us. No, we say. Another time. We are scheduled to have cena (the light evening meal) with Chelo in a few minutes.

We arrive back at the house, let ourselves in through the gate, and go up to our room. We had opened the windows in the room to let some air in and now we are being punished for it. Although the evening air is somewhat cool outside, the room is a virtual oven, or at least a virtual bun warmer. We each take cold showers, change our clothes and go downstairs

Chelo is making quesadillas with flour tortillas and cheese from Oaxaca (sorry, Suebob). Everyone always eats corn tortillas in this part of Mexico. I had told Chelo at comida that I was from Texas and that my family always ate flour tortillas -- as the people of northern Mexico also do. (I love corn tortillas, don't get me wrong -- but flour tortillas are the tortillas of my heart.) We tell her that we don't need her to walk us to school in the morning because we have passed by it during our evening walk (I attended the same school several years ago.) The quesadillas are delicious and I am touched by Chelo's gesture of getting some flour tortillas to make me feel at home.

Upstairs, the room is still hot enough to warm buns. Kenny and I take two more cold showers. We strip down to virtually nothing and lie in the dark each of us on our own bed. I have wet wash cloths strategically placed. The fans are on high. I take half an ambien and a benadryl and pass out almost immediately to the sound of a ceiling fan in need of repair. Cuernavaca is known in Mexico as the city of eternal spring -- and when I visited in the past (in December and January) it was very springlike. Now, with global warming, I think it may have graduated to the city of eternal summer.

The air in the morning is crisp and cool - springlike, indeed. As we walk into the main house for breakfast, a wall of hot air hits us. Breakfast is a plate of cut up watermelon (the fruit in Mexico is a miracle of ripeness and freshness and taste -- and worth the risk of diarrhea), toast and a tub of margarine that looks as though it could have been purchased in 1978, and a plate of scrambled eggs (tomatillo salsa on the side). We eat and head off to school for our placement tests. The school is in what was once a house. It is a lovely property. Kenny and I are each handed placement tests. Kenny, smiling, writes his name on the top and then hands it back, confident in his total lack of Spanish knowledge. I struggle with mine. Subjunctive? Conditional? At one point or another in my life, I have mastered (on paper) every Spanish tense, every mood. Unfortunately, lack of use has driven all of that information from my mind. Now, at work, I rely on simple present and simple past to communicate with my patients. The test frustrates and embarrasses me. After the test, we each have a brief interview. During the interview, it comes to me (in that weird, free association way that realizations are made at inappropriate times) that I had told Chelo that Kenny was allergic to bones (I was trying to tell her that he is allergic to nuts.)

Kenny and I are assigned to our respective classes: Kenny to the beginner class and I to some kind of intermediate one. There are three other people in my class and one of them has the same name as me! We trudge through some grammar (the conditional tense) and make up sentences to say to each other using our new conjugation. My teacher looks a little like Jennifer Lopez. I love the slow clear way she speaks Spanish. Each word is distinct. Over the next five days of class, I will appreciate her amazing teaching skills more and more. I will also start to feel guilty that I am benefiting from these skills -- she wouldn't be able to support herself if she taught Mexican children.

The other students I meet:

Sandy and Maureen. Two well-off white women in their 50s from the midwest. They are having a daring adventure.

Neil. He is staying in our house. He is a travel writer and is actually on assignment.

Mark. Heavily tattooed, mid twenties, from the deep South. Came to Cuernavaca 4 months ago unable to say hello in Spanish. He is leaving in a few days. His grammar is atrocious, but he has a fluidity to his Spanish speech that I envy. He tells me that he dreams and thinks in Spanish now. He seems like his heart is breaking at leaving Mexico.

Anna. A recent law school graduate from the mountain time zone. Is thinking about taking a job in personal injury law in the South.

Chislan. A French Canadian guidance counselor -- he is very fit, in his fifties, and talks about Jack Kerouac at every opportunity. It will take me three days to realize that the reason that he is so hard for me to understand in Spanish is that his first language is French.

By lunch time, Kenny is in a foul mood. He is unused to being a novice in a field of study. The day has been an exercise in frustration for him. He is the least experienced Spanish student in the school. We go home to have a comida of cecina with our family (I'm still not really sure what cecina is -- a sort of wet, cooked beef jerky -- better than it sounds) Then Kenny and I head for the air conditioned mall on the other side of town. We watch August Rush (in English) and then go to Sanborne's for beers and coffees. On the way home, we get caught in a delicious rain storm. The taco family offers us shelter and tacos, but we're full and delighting in getting wet.

When we get back to the room, we find that it is much cooler at night if you close the room up tight during the hot part of the day. We have done this. After cool showers, we head to bed.

Neither one of us has had a bowel movement in Mexico yet.

Cuernavaca Journal: Day I

2008-04-21T23:02:00.003-04:00

Kenny and I got up at about 0430 this morning in order to make a 0930 flight to Mexico City. For the first time EVER, since I started buying discounted plane tickets online, I didn't get flagged for special screening in security. What a luxury.

We are going to Cuernavaca, Morelos, Mexico to study Spanish at a little school called Chac-Mool -- for about a week. We will be staying with a host family in the same neighborhood. Despite the fact that I have taken 7 years of junior high, high school and college Spanish, I am far, far from fluent. However, I can say things like: Please bring me a beer with some lime or I am going to start your IV now. Kenny's mastery of the language is limited to: Hello and I'm sorry. We come armed with dictionaries, verb books, phrase books, and two types of antibiotics.

Our flight lands and then proceeds to sit out on the tarmac for about 20 minutes. ??? Apparently, our plane is too big to negotiate the runway we are on and nobody noticed this until just now. Finally, we get tugged to the gate. Immigration and customs are surprisingly quick and suddenly we are looking for our driver, Vicente, who will take us to our host family's house in Cuernavaca, which is about an hour's drive from Mexico City. We buy some bottled water in the airport and go to the car. I make a tiny bit of conversation with Vicente. Kenny tells him hello and that he's sorry. I sit in the car, letting the wind whip my hair around my face (something that I would never allow in the states) and think about how funny it is that Kenny, who is the real talker in our family unit -- and usually our main emissary of good will to the outside world, speaks no Spanish, while I, the mostly silent one, can actually navigate the language. We are in for an interesting week.

We arrive at the house just in time for la comida, the afternoon meal. The day is sunny and breezy and warm -- I anticipate a house of open windows, ceiling fans. Unfortunately, the house is shut up tight, the fans are all off, and the kitchen is right next to where we will be eating -- so that our dining area has been, in effect, pre-heated. At the table sits an American man eating. We say hola, go to our rooms to put our bags down, but by the time we return, he is gone. We eat a meal of chicken in guajillo chile sauce, iceberg lettuce, pinto beans, tomatillo salsa, and corn tortillas. Our hostess, a grandmotherly woman named Chelo, tells us that she disinfects the lettuce for her American guests. (This is really nice -- because the main way that American's contract Montezuma's revenge is through water contamination -- which means that any raw veggies washed in plain tap water are suspect and to be avoided.) The meal is homey and exotic and delicious all at once. Chelo is the Mexican version of Kenny's grandmother. The dishes and flatware are all mismatched -- there is nothing that appears to have been purchased before about 1978. However, Chelo appears to have a full-time housekeeper and gardener. Although the meal is delicious, I am actively sweating as I eat. (Over the course of the next 8 days I will become familiar with the strange sensation of simultaneously dreading and looking forward to a meal -- the food was always delicious, but the heat in the room was always unbearable.) This is a cultural difference that we become more and more familiar with as the week progresses. Whenever Kenny and I are comfortable (while wearing sleeveless shirts and shorts) the Mexicans will be wearing long pants, long sleeves, sweaters, and once, a long leather coat.

After the meal and much awkward Spanish-only conversation, Kenny and I retire to our room. We walk out of the kitchen, through a little courtyard/utility area and up a narrow flight of stairs which is made narrower by the placement of at least two potted plants on every single step. Upstairs, our room is plain but serviceable. We have two fans, two beds, a desk, a dresser, and a bathroom with a shower. I will come to love this shower over the next eight days. It has a large tiled bench -- a feature that I wish I had in my shower at home. (Makes for easier leg shaving for those of us over 40).

Once Kenny unpacks and I promise him that I will unpack tomorrow (I never did), we go out for a walk around the neighborhood. We stop at a little taqueria on the corner, La Puerta de Oro del Bahio, for beers. The last time I was in Cuernavaca, Rosario, the proprietess of La Puerta told me (I think) about a door in the upstairs room of her house that leads to another dimension. The walls are covered with pictures of UFOs that have been sighted around Mexico City and Tepotzlan. Every available inch of floor space is home to a potted plant, or old bleach bottle full of scummy water and a vine of some kind. I have a couple of Negra Modelos a la cubana -- with lime and salt. These cost me about $1.25 each. I realize, as I am draining the dregs of my first one, that it has been poured over ice -- which is the way "a la Cubana" is usually served. I have been on the ground in Cuernavaca for less than an hour and I have already broken the "no ice in Mexico" rule. Oops.

Baby in the Bed

2008-04-20T20:17:00.003-04:00

So, I kind of knew that the day was going to suck when I got my assignment in report. My patient was 42, pregnant with her first baby, and had brain damage and chronic pain from a car accident she had been in as a teenager. She had basically never been to see a doctor from the time she was released from the hospital in 1979 until she got pregnant. To control her pain? She had been smoking pot daily. To her credit, she freely volunteered this information to her OB and to the nurse who admitted her. She was being induced for IUGR (Intrauterine growth retardation -- there is actually a more PC term for it now than retardation, but I've had a couple of beers and I can't at the moment recall it). Just after I got report, the MD called (did I mention that he's kind of a dweeb?) and ordered a bunch of blood tests and a UDS (Urine drug screen). I have to admit that I don't really get this. Why order a test to confirm what a patient has already told you? But, whatever.

So, I'm in the room. I have a student following me. It is her first day EVER on L&D. I've already got the urine, and I've just stuck a butterfly in this poor woman's AC. I'm drawing like 4 tubes --butterflies are kind of slow, so we're chatting -- which is kind of hard -- because my patient has a speech impediment and a total lack of teeth in addition to the brain damage. Anyway, I'm filling up that first tube and I hear screaming from the room next door.

Oh, sounds like someone is having a baby, I say, when I see that my patient is reacting rather negatively to the screaming. The screaming continues. I start to realize that something is, just, well, wrong with the screaming. First of all, I only hear only one voice. Usually, when someone is screaming a baby out, they have a nurse and a doctor or a midwife -- and everybody is being loud. Push, you might hear. Or, Don't push. Then I realize that what I'm hearing is Ayudame, Ayudame. Which is Help me in Spanish. So I finish up the blood draw and tell my student and patient that I'm just going to stick my head in next door to see if they need anything. My student very sweetly offers to go check on the patient next door. Nah, I say. I'll do it. Did I mention that we were in kind of an out-of-the-way corner of the unit? So I open the door, and I see a sweet-faced hispanic woman sitting up in the bed holding a baby between her legs.

Oops.

I hope she doesn't get a bill.

So, we got that handled and, then, later, my patient's UDS comes back. NEGATIVE FOR CANNABIS!!

How shady is it to sell fake pot to somebody with brain damage? That ain't right.

Tomorrow, Kenny and I are leaving for Cuernavaca, Mexico for 8 days. We will be studying the Spanish and drinking the beer.

I've Got a Call on Line 2

2008-04-17T20:38:00.003-04:00

We have a bathroom in our nurses' lounge. On my first day of work, I got oriented to the bathroom by one of the other nurses:

No pooping in there.

We eat all our meals about 3 feet from that toilet, so it just makes good sense. But where can we poop? Most of us work twelve hour shifts. We poop at work. It's just biology, dude. People poop - even nurses. Well, there is a toilet in the recovery room, and one in the preop area. These are both good choices as long as there aren't any patients in recovery or preop. There is also a bathroom in the sterile supply room. The sterile supply room potty is my favorite. It's pretty private and you have access to a sink -- in case of, well, extra messiness. However, recently, one of our nurses decided that we shouldn't be pooping in their because, get this, poop stench contaminates sterile supplies. Well, maybe it does -- but, if so, maybe they shouldn't have put a toilet in there.

I don't know if it's anxiety or just my schedule, but I almost always have to poop right after I get report (I call it "getting a call on line 2.") So, the other morning, I'm taking my call in the sterile supply potty. Right on the other side of the wall is the preop area -- and I can hear the nurse who has banned pooping in sterile supply admitting a c-section patient right on the other side of the wall! It was sort of inhibiting, but I worked through it eventually.

Congratulations! It's a Mucus Plug!

2008-04-15T20:39:00.004-04:00

When I have a patient in labor, I have to make sure that I chart pretty much every single little thing that happens. But, especially, I have to chart certain milestones. Like...your due date...the first day of your last menstrual period...when your labor started....when your water broke, when your cervix in dilated to 10 cm. When the baby is born...when the placenta is delivered. But, you know what IS NOT A MILESTONE? When you lost your mucus plug. I don't really care. Your doctor doesn't care. Your midwife doesn't care. If you call your midwife at 3 am to tell her that your mucus plug is currently exiting your vagina? and she tells you to put it in a baggie and take in to the office the next day to show the other midwife? She's probably really mad at that midwife (or has a really sick sense of humor -- K, you know I'm talking to you -- and it was just WRONG!)

Actual Overheard Conversation

2008-03-04T13:24:00.003-05:00

I walked into the tail-end of a conversation this morning at the nurses' station. I don't have any idea how it started. It was between one male doctor and about 4 female nurses.

Doctor: I'd really rather have one experienced woman than 70 virgins.

Nurse1: Not interested in the virgins, huh?

Doctor: Well, it's not that I'm against virgins, it's just that they'd all probably be 15, 16 or 17 -- you know how crazy girls are at that age.

Nurse2: Yeah, they'd probably be texting you all the time.

Nurse3: Do you think I'm pretty?

Nurse4: I'm outside your house right now.

Nurse2: I'm thinking about you, are you thinking about me?

Nurse1: Who was that girl you were with last night?

Nurse4: Do you think I'm fat?

I can kind of see his point.

2008-02-27T20:03:00.000-05:00

Enter the ICHC online Poker Cats Contest!

Rough Day

2008-02-27T05:06:00.003-05:00

I'm not saying that yesterday was a bad day...but...I had a new hospital administrator following me all day (working toward her requisite number of clinical observation hours) and my first patient was a (very nervous) prosecuting attorney.

Needless to say, I charted my ass off.

Congratulations Diablo Cody!

2008-02-24T23:27:00.000-05:00

A blogger just won a fucking Oscar!

Videos of Births are Scarier than Real Life Births

2008-02-24T14:02:00.003-05:00

I have to do a NRP (Neonatal Resuscitation Provider) recert on Wednesday. So, of course, this weekend? I'm cramming my ass off. This year I have the CD that comes with the book, which for some reason, makes cramming more fun. This morning, sitting on the couch next to Kenny (both of us on our laptops), I installed the CD for the first time. It has videos and stuff. The first video started with a normal vaginal delivery. I tilted the screen toward Kenny.

Look, sweetie, that's what I do at work everyday.

OH MY GOD I CAN'T BELIEVE YOU WOULD JUST SHOW THAT TO ME WITH OUT EVEN WARNING ME THAT I WOULD BE LOOKING AT SOMETHING SO...OH MY GOD IS THAT A BABY? IT'S COMING OUT OF HER...OH MY GOD! IS SHE GOING TO LIVE? JESUS. I THINK I'M GONNA BE SICK...YOU LOOK AT THAT EVERYDAY?

He jumped up of the couch and started to pace around the room muttering.

I'm sorry, Kenny, I didn't think before I showed it to you. Are you ready for some breakfast? How about a nice soft-boiled egg with toast soldiers?

EAT? AN EGG? ARE YOU KIDDING ME? I DON'T KNOW WHEN I'LL EVER EAT AGAIN. I'M GONNA GO LAY DOWN FOR AWHILE.

Oops.

Oh, the Humanity

2008-02-21T23:50:00.003-05:00

I've been really enjoying reading some other nurse blogs lately -- both the blog entries and the comments. But I've been noticing something that disturbs me in a way that I'm not sure I can articulate. It has to do with the way people react when nurses bluntly tell the truth about how hard our jobs are. This post, that deals honestly and gently with some of the difficulties that arise when providing gynecological care to obese women, inspired some very heated comments. This post, which takes a very different tone, also inspired a lot of anger. I enjoyed both of them and, at the same time, I totally get why some readers are pissed (by the second one, anyway).

It's hard to be a nurse. It's hard when you're expected to care more about a person's health than that person does. It sucks when you injure yourself moving an obese patient from the operating table to a stretcher. It is heartbreaking when you see a bad outcome that could have been avoided by better self care. It's awful and gross to check the cervix of a woman who hasn't bathed in the recent past. And it is especially difficult when you have to do all these things repeatedly during a twelve hour shift that is so busy that you are unable to take time to eat, drink or urinate.

But it is also wonderful to be a nurse. It is very rewarding to help someone through a frightening experience. I love it when I am able to win the trust of a patient who arrived feeling ashamed of something she had done while pregnant -- smoking, drinking, drugs, attempting suicide...because nothing that anyone is or has done takes away her right to have a supportive nurse during labor. And I give the best care that I possibly can - to every patient. And I think the midwife and nurse I linked to above also give the best care that they can. But, you know what? It wears us the fuck out sometimes! We're human. Most of us have not taken a religious vow. We are simply people who do a very difficult job. We need to blow off steam occasionally so that we can continue to ruin our health to keep you alive for one more day.

Good People

2008-02-11T08:32:00.000-05:00

The other day I was taking care of a woman in preterm labor. She was Nigerian and the only person who came to see her was a sweet middle-aged Hispanic woman. My patient was 33 wks -- and by the time I got report on her it was pretty much a given that we weren't going to be able to stop her from delivering some time during my shift. She was scared, had apparently left all her family behind in Nigeria, and just had this one Hispanic friend. Now, I live in a very diverse community. We have a large Hispanic population, large Asian population, and a significant number of Nigerian (and other African) immigrants, Bosnians, and (since we are here in the shallow south) a fair number of hillbillies. Some of these communities are old enough, and well established enough, that they are starting to blend a bit. I saw my first Vietnamese/Mexican couple recently. And, for quite some time, we've been seeing large, blonde, white women with little bitty Mexican men. So, I didn't think anything of this cross-racial friendship. It seemed to be quite a tender one. I walked in to find the Hispanic woman gently mopping her friend's brow with a cool cloth. After several hours, she told me that she had to leave, but she wanted to give me her cell phone number in case her friend needed anything. I smiled, took the number, and asked how long they had been friends.

Oh, we just met today, the woman told me. I just stood there with my mouth hanging open for a minute.

How did you meet?

I picked her up and brought her to the hospital. I'm a taxi driver.

When the Ambulance Comes...

2008-02-03T11:23:00.000-05:00

The other day I was driving somewhere to do something on my day off. While I was stopped at a red light, I watched an ambulance go through the intersection with its lights on and sirens blaring. And you know what the first thing that went through my mind was?

Probably a big faker.

When did I get so jaded? While I was at work, that's when. Sometimes it's necessary to come to L&D via ambulance. But not when...

you are full term with your first baby and contracting every 25 minutes

you are scheduled for an induction (and your family is going to meet you at the hospital)

you have a pink spot the size of a dime on your panties

you had a mild headache 3 days ago

you just remembered you have sickle cell trait (not disease...just trait)

you are 24 weeks pregnant, have not started prenatal care yet, but you are really curious about the sex of the baby

Lately, because of some construction at my hospital, people have been mistaking L&D for the ER. When that happens, we have to send a nurse to evaluate the patient and then call the ER to give report and then a hospital employee escorts the patient to the ER. I've heard stories of guys showing up to L&D looking like they are in the middle of an MI, or drunk with obviously broken bones (a foot turned the wrong way), or a suicide attempt...but whenever I go up to evaluate someone? Not so exciting. The other day it was a guy who hurt his arm 3 weeks ago and every couple of days it still bothers him some. Why is this guy going to the ER? Because he doesn't have health insurance -- so he doesn't have a relationship with a primary care provider -- so he doesn't really know where else to go. He knows that it isn't an emergency, but he also knows that something is wrong with his arm. Is this a misuse of the ER? Sure. Is it completely this guy's fault? I don't know. But it sucks getting hurt or sick when you don't have health insurance. Are you waiting longer for your emergent care because of people like this? I actually don't think so...because if the ER wasn't full of uninsured folks using it as their primary care facility -- then the hospital would cut the staff back by at least half. And you'd still have to wait.

Smells Like Vagina, and a Little Bit Like Potatoes

2008-01-24T14:31:00.000-05:00

The other day at work I only had one patient while everyone around me had two...Why? Because my patient had delivered her baby, but not her placenta -- and could end up being a surgical patient at any moment. She was a 23 week IUFD (Intrauterine Fetal Demise). Sometimes the placentas don't come out on their own and we have to go to the OR for a D&C.

It was a busy day so I was floating around, watching patients while their nurses got theisr other patients an epidural or whatever.

Several times I watched a certain patient for K. This patient had SROMed the previous morning -- at 36 wks gestational age. (SROM = spontaneous rupture of membranes) and was being induced. But her cervix had not changed, not at all. And she was pretty much a shoe-in for a C-Section, but her doctor was delivering babies and going to the OR with true emergencies all day, so she kept being put on the back burner.

When a patient has been ruptured for a long time, the smell of amniotic fluid (which is not unlike the smell of vagina) begins to permeate the room. Her family had been eating all of their meals in the room also, so it smelled like whatever they had eaten last (french fries, the first time I went in to take a temp).

Later I gave this woman some IV nubain and phenergan for her pain (and her vomiting up all the french fries that she shouldn't have eaten in the first place). I told her that she could not get up out of bed under any circumstances for at least the next hour. She was a big girl. Real big. There was no keeping her from falling if she started to go down, you know? She already had a foley catheter -- I'm not exactly sure why, she wasn't my patient, I was just watching her, right? So I give her the IV pain meds. Guess what the first thing she told me was!

I have to move my bowels. She told me. Great.

Well, I'll get you a bedpan, because I can't let you walk to the bathroom right now.

I leave the room to give her some privacy. Because, who likes to shit with an audience? I'm sitting at the nurses station doing some paperwork for my patient when I notice that the pooping patient has unplugged herself from the external fetal monitor. Hmmm. I get up and run back to the room. She is standing naked by the side of the bed. The bedpan (full to the top with one of the most impressively large and aromatic bowel movements that I have EVER witnessed) is on the bathroom floor.

I got her a new gown, cleaned her and the bed. Cleared away the evidence of bowel movement. Really, how embarrassing must that have been for her? Poor thing. She was pumped full of narcotic and was just trying to be polite, I think.

I thought that maybe that poo cleared the way for the baby to come down. But she had her section during the night.

Be Careful Not to Dry Out Your Vagina!

2008-01-17T12:56:00.000-05:00

Suzanne's most recent post reminds me of when Kenny and I were dating. I really wanted to take a hot bath one night at his house, but his tub was really yacky looking. Those of you who know us might be surprised by this, because Kenny is really the better housekeeper of the two of us. But he was a showerer and, like most showerers, didn't necessarily scrub the tub out regularly -- although it did get some sort of cleaning on a regular basis. On the other hand, I am very messy, but scrub my tub till it shines on a regular basis (because I'm a bather more than a showerer.)

Anyway.

Do you have any comet? I asked him.

No, but I just cleaned the bathroom from top to bottom a few days ago. That tub is just really stained. But I guarantee that it's clean.

So I drew my bath and soaked in it for a good long time. As I was drying off, I happened to glance down into the now almost empty tub. And what did I see? A big white ass print from where my butt had apparently de-scummed his tub.

Surprise!

2008-01-17T10:34:00.000-05:00

I hate being on call. We alternate between taking 12 or 8 hours of call per month. I don't mind working my call, but I despise being at home waiting for that phone call to come. So, every once in a while, I sign up for 4 hours of call at the end of a 12 hour shift -- I like to see my old night shift peeps and I generally know as the day progresses what the odds are that I will be asked to stay.

One day last week, I had a really busy day. I had a pretermer on mag and another pretermer with a partial abruption on observation. Although this could have been a really easy assignment on night shift (my former home), the perinatal specialists come to see the antepartums during the day and they can be pretty high maintenance. Add to this the fact that I don't know any of the specialists because they never, ever come at night. Not knowing docs (and being able to anticipate their needs) can be really exhausting. You end up running your ass off.

At 6:30, I go up to the lounge to get my lunch bag so I can make a quick escape after I give report. I am really eager to give up these patients. The abruption has turned out to not actually be an abruption -- but a pulled muscle. (Don't get me started on that one, ok?) She is sweet, but she has a major pain in the ass family. They have actually called me in the room to ask me to find someone to fix the DVD player they brought from home... My pretermer on mag? She is 14 years old. A young 14. She doesn't really understand that her baby shouldn't be born at 26 weeks. I've talked to her, her OB has talked to her, I got a doc from the NICU to talk to her, a social worker has talked to her, and after every frank, grave talk she asks, "but my baby is going to be ok, right?" She is a child and just doesn't have the capacity to understand what's happening to her. And she is so tiny and innocent and scared and, frankly? She is breaking my heart. Add to this the fact that I had turned off (per doctor's order) the mag at 3 pm and she is starting to bleed and contract. Oh, and the baby is a footling breech -- so she'll have to have a C-Section when the time comes. And it is looking like the time might come tonight. I just don't have the emotional strength left in me on this day to go with this girl to the OR.

Imagine my surprise when I exit the lounge at 6:30 and M, my friend who will be in charge starting at 7, looks up from getting report and says to me, so you're my call girl from 7-11, huh?

I laugh and tell her to please shut up.

No, she says, I'm serious.

Fuuuuuuck. How did I forget that?

I ended up staying until 11. And then? I had to walk to the lab -- in a different building -- because I put one patient's sticker on the other patient's 24 hr urine. I got home after midnight. And, let me tell you, there was drinking going on when I got home.

Update: My teenage pretermer stayed pregnant for about another 24 hours. The baby is in the NICU now and is doing amazingly well. And the staff in the NICU is really impressed with the girl's attentiveness and caring.

Just Thinking

2008-01-16T14:08:00.000-05:00

So, first of all, I called in sick to work today. And I feel guilty. I really am sick -- I've got some kind of stomach virus -- I'll spare you the gory details. I think I faked sick too much when I was a kid, or something -- I'm not sure I was ever actually sick as a kid -- but you'd never know that from how often I went to the nurse's office. I could be stroking out and I'd still feel guilty calling in sick.

I wrote a post yesterday about an awesome birth that I was involved in and a doula, whose beautiful blog can be found here, left a comment that at first made me feel defensive, but then made me think.

When I decided that I wanted to go into L&D, I really believed that the medical model of birth that prevails in this country was flawed. But then I started working in L&D. Many of my patients are not healthy. They have significant health problems that have either started during pregnancy or been exacerbated by the pregnancy. They are usually not interested in a natural approach to labor. Because I deal with so many sick patients, I think I (and other L&D nurses) often forget how to deal with the healthy ones.

Caring about your health, really taking care of your body with exercise and good diet puts you in the minority in this country. The medical model of birth is, I think, more and more about dealing with sick pregnant women. Is it any wonder that healthy, fit women often complain that the health care they received was too invasive, not suited to their needs? What do you think?

Going Natural

2008-01-15T21:43:00.000-05:00

So, today I had one patient all day long. She was being induced because her baby was past-due. To put it mildly, she didn't tolerate the vag exam. Hated it. It was really uncomfortable for her (not that its fun for anybody, but some people tolerate it better than others). She was planning on going natural because she was afraid of needles. This was her first baby.

Whatever.

When her doctor came by and checked her, he encouraged her to get an epidural because, well, the baby's head was going to be a lot bigger than two of his fingers...During one vag exam, the doc actually had to ask her to unclench so he could get his fingers out.

I offered her an epidural several times. (I support people going natural, I really do. But I was really worried about her -- usually if you can't tolerate the exam, the delivery really sucks for you, ya know?)

Right before shift change she was complete. She pushed through about 4 contractions before we had the baby.

She never had an epidural and she never made a sound. Not one. She was amazing.

Second Time Around

2008-01-14T10:02:00.000-05:00

The other morning I got report from T (a night shift nurse) on a patient. It was her second baby, no risk factors, she was a health care professional, yadda yadda. I looked over her chart and then went into her room to meet her.

Hi, my name is Working Girl....

Hey, her husband said, we had a Working Girl 3 years ago with our first baby....but I think she was a student...

Ok, it was me and I wasn't a student, I was a "nurse resident." The thing was? I got her vag exam all wrong. I checked her after her epidural (before the epidural she had been 3 cm) and called her 3-4. But then she told me she was feeling pressure like she had to poop, so I called my preceptor in to check behind me. She was complete and ready to push!! What happened? One of two things. Either she changed really fast -- I now know that it does happen. OR...I had my fingers in the baby's scalp. (I think this is actually more likely) Checking a cervix used to be such a mystery to me.

So, as I was standing there, it all came rushing back to me. Oh, yeah, I said. You used to have long hair. You're a nurse anesthetist and you work over at County Hospital, and I checked you and thought you were 3 cm, but I was wrong and you were really complete!

She nodded and looked sort of uncomfortable.

I'm a lot better at that whole vag exam thing now. I told her.

She and her husband laughed and (I think) we had a good labor after that. But the funny thing is that, on that same day, I was asked to precept a senior student from my alma mater. I said yes, and I'm really excited about doing it, but part of me is flabbergasted. ME? Are you sure you want me?

At evening shift change, I saw T again. I told her the story of my first experience with the patient.

Oh, T told me, while I was admitting her she told me that she had had a student nurse the first time who totally screwed up her vag exam...

Nice.

did you want the cottage cheese or the pate?

2008-01-13T09:13:00.000-05:00

This was my first post. I wrote it while I was still in nursing school and posted it on my short-lived yahoo360 blog. I just found out that I'm going to have a senior student this semester...and it made me nostalgic for old times:

Med/surg exam this afternoon! It is twenty minutes before test time and I am approaching the computer lab where the test will be administered. I got up at 2:oo this morning to cram some more nursing facts into my brain. I've had so much coffee that I've gone beyond the caffeine buzz into a strange, tired jumpiness. I enter the ladies room (because I'm a lady).
"How much time did you spend studying gynecological topics?" My friend, J, is in the next stall and, apparently, can identify me by the unique sound of the flow of my urine.
"Not so much," I reply. Our Med/surg instructor has informed us that gynecological topics will be covered in more depth in our OB class next semester. "I'm much more worried about the renal stuff than the twat stuff."
"I can't keep all of the vaginal discharges straight, " J tells me. "And it just grosses me out when they get compared to food." This is too true. In the medical and nursing world, all vaginal discharges are identified by what food they most resemble. The discharge produced by a yeast infection is ALWAYS compared to cottage cheese. Other discharges are "fishy." The normal vaginal discharge produced when a woman is fertile is compared to egg whites. What's the deal?
I commiserate with J. "Comparing vaginal discharge to food is just wrong. I mean, you never hear anyone comparing food to vaginal discharge. You would never ask a waiter how the pate is and have him ask you back, 'well, have you ever had trichomoniasis? You know that discharge you get with trich? Our pate is a lot like that!'"
J thinks this is hysterically funny. We are still laughing as we enter the computer lab -- until we get "the speech." Apparently, our instructor spent the previous afternoon watching the Dr. Phil show about rampant cheating in high schools and colleges. "Ok guys," she brays, "sit in every other seat so you won't be tempted. We don't want anyone ruining their career because they can't control their impulse to cheat." I am very insulted by this. Later that evening, I complain to my husband, K, about the instructor's assumption that all students cheat. He teaches philosophy. Unfortunately, he informs me that in a recent poll of undergraduates, something like 78% of them admitted to cheating. So much for my righteous indignation.
The test begins. J is sitting one seat away from me. I see, out of the corner of my eye, that she is trying to get the instructor's attention. Finally she does. She points to a question that is asking about the signs and symptoms of some syndrome or disorder -- I can't remember what it was now. But one of the possible answer choices was, "noncreative pupils." J points to this selection and tells the instructor, "I am unfamiliar with this condition." We all knew it was supposed to be nonreactive pupils. But nursing school does something to you -- you have to ask those questions. Never assume you know what the typo really means! You're screwed if you do.

Vaginaromatherapy Revisited

2008-01-08T11:57:00.000-05:00

The other night I had to admit a stinky patient. She wasn't stinky in a stale "I never bathe kind of way," but rather in an "I worked hard all day and then accidently went in to labor before I could shower" kind of way. I didn't really have a problem with this. It isn't my favorite thing, but, what are you going to do? Her water broke, and she went right to the hospital -- just like her doctor told her to do. Then her husband and sister arrived. Apparently, they had also had hard days at work since they last got busy with some soap and water. This was definitely a bummer. The patient was a primip (first time mom) and this labor might take a while! She labored all night long, and when I left in the morning, she was nowhere near complete (ready to push).

The the next night, I am assigned the same patient. She still hasn't delivered, and her doctor is starting to talk c-section. I go into the room to say hi, and am overwhelmed by the atmosphere. Twenty-four stressful hours in a smallish room has not made anybody smell any better. Apparently neither husband nor sister has run home for a shower -- and someone has been eating fast food. I can smell the old grease. All of the different aromas -- old fries, armpits, vagina, halitosis, stinky butts, and I think someone is a smoker, too -- all these smells have come together to create a sort of uberstench -- it's like an abusive fourth family member, quiet but still dominating. I do what I can do to freshen things up, but without being able to actually scrub down hubby and sis, I'm not sure I've made a significant change.

The doctor comes in to assess the situation. I meet her just as she's opening the door to go into the room so I don't have a chance to warn her. She's just coming on call for this particular practice and hasn't seen the patient (outside of the office) yet.

The patient and her sister are in the room, but the husband is absent. The doc does a vag exam and determines that the patient is still only 7 centimeters dilated -- she's been 7 for hours now. The doc starts talking to the patient about the possibility of a c-section. The baby's heart rate is fine, and if you want to wait a couple of more hours to see if you can make any change, that's fine, but I know you're very tired. The patient is crying and scared and asking all of the typical questions that patients ask at this time. Just then, the toilet flushes in the bathroom and a few seconds later the door opens and out comes the husband along with the powerful aroma of fresh turd. Do you think he shut the door behind him? Not a chance. I watch the doctor as she talks to the patient and the husband about the c-section. As the new smell wafts over the bed, her face tightens just a bit. She looks at the patient, Let's go on to the OR, dear, and get this baby out.

The official indication for that c-section was "failure to progress," but, really, we just couldn't breathe in there anymore. (The baby did have a really big head and could have never come out through that particular pelvis.)

Daily Show Comes Back Tomorrow!!!!

2008-01-06T16:28:00.000-05:00

Tomorrow night, he'll be back! Until then, here's a little vintage Jon for ya.