The Doctor Stole My Stethoscope

Quote of the Day

2013-01-01T17:09:00.002-08:00

Seen in a History and Physical written by an Orthopedic Surgeon:

"The patient became extremely hypothetical and required 2 mg Ativan PO for sedation."

The Explanation for my Absence

2012-10-23T10:46:00.000-07:00

September 14, 2012
8:37 pm

Outstanding Product Placement

2012-03-17T10:19:00.000-07:00

A Quick Comment on Nurse Managers

2012-02-25T07:39:00.000-08:00

A Nurse Manager who wears scrubs to work = Nice

A Nurse Manager who will step in and take patients when things are crazy = Priceless

Recovery Room Quote of the Day

2012-02-16T11:44:00.000-08:00

A cranky older gentleman when informed that he must wait until he is transferred to Phase II recovery to get dressed and leave:

"You call this a hospital? It's more like a laboratory."

Follow up: In my report to the Phase II nurse, I mentioned that the patient was "a little grouchy". The Phase II nurse stopped by later and accused me of giving her a grossly inaccurate report. She said "Grouchy was not the word. That guy was actually an asshole". Ahhh...technicalities. Tomato/tomaahto. I guess one person's grouchy is another person's asshole.

The Duke Knows

2012-02-07T05:40:00.000-08:00

Busy

2012-01-30T11:47:00.000-08:00

I have not posted in awhile and am full of excuses:

1. We have had a mass exodus of nurses, respiratory therapists and techs from my somewhat hoodish hospital. Beautiful -New -Suburban -All Private -Room -Hospital -With -A -Gourmet -Chef has siphoned quite a bit of our staff away. Shortstaffing has led to chaos and lots of overtime for everyone.

2. My professional mentor was fired recently (a blogpost for sure when I get the emotional distance to write about it), leaving me sad and discouraged. I do know, however, that if Florida had unions, it sure as hell would not have happened.

3. PACU traditionally consists of 4 ten hour shifts a week, plus weeknight and weekend call. We have had a few nurses leave who want to go back to the 3 12 hour shift workweek. More overtime for me!

4. When I get home, I want to play with my kids and sleep. I know I need to exercise, but soooo tired. Maybe I will lay my head down on the table right now........................................

A Weighty Issue

2012-01-03T09:00:00.000-08:00

I checked out a new blog today and saw a blog post after my own heart. My fellow Recovery Room nurse put into words a conversation I have had with several patients. At http://recoveryroomriley.blogspot.com/2012/01/worn-out-joints.html this nurse talks about how an obese patient cannot for the life of her figure out why all of her weight bearing joints are deteriorating and need to be replaced.
I have noticed this same thing with many of my patients. They do not understand why they need to get their knees and/or hips replaced, why they are hypertensive, why they have lower back pain. Many do not even realize that they are obese. Are their physicians not discussing this with them? Now keep in mind that I am not talking about the pleasantly plump individual or the person who has "a little more to love". The patients to whom I am referring are truly in the category of obese, sometimes morbidly so. And it is not just the patient's health that is affected. Every time they pull a 400 lb patient up in their bed or transfer a 350 lb person from a stretcher to a bed, health care workers sigh in relief when their backs emerge unscathed.
How do we get the collective American waistline to shrink a bit? This gentleman at CNN compares the response needed for this issue to the war on smoking and even more so to the campaign to reduce highway fatalities cnn.com.
Now my muffin top has grown from barely noticeable to semi-in-your-face over the holiday season, so I am certainly not immune to the pleasures of pumpkin pie, fudge, and cookies. However, seeing the debilitating health issues that my obese patients face absolutely does help motivate me to not let my weight get too out of control, kind of like old ladies with broken hips inspire me to take my calcium. It is hard in a world where processed, sugary and fatty food is less expensive than fresher, more nourishing choices to always do the healthy thing. However, if we can just get ourselves to the the healthy thing a little more often, I think we could make some giant gains...or giant losses in this case.

New Year Cookies

2012-01-01T11:59:00.000-08:00

In the South we have some New Year's culinary traditions. Often the New Year's Day dinner consists of a slow cooked pork roast, greens, and black eyed peas. Some people say that eating greens, such as turnip greens, collards or spinach will ensure a healthy cash flow in the new year. It is also thought that eating black eyed peas will bring one luck throughout the coming year. Courtesy of Wikipedia:

"The peas, since they swell when cooked, symbolize prosperity; the greens symbolize money; the pork, because pigs root forward when foraging, represents positive motion. Cornbread also often accompanies this meal.
Another suggested origin of the tradition dates back to the Civil War, when Union troops, especially in areas targeted by General William Tecumseh Sherman, typically stripped the countryside of all stored food, crops, and livestock, and destroyed whatever they could not carry away. At that time, Northerners considered "field peas" and field corn suitable only for animal fodder, and did not steal or destroy these humble foods.^"

Some hardliners insist that it is necessary to eat 365 black eyed peas at the meal to be lucky all year, but that seems like a lot of peas to me. Flatulence galore! When I lived in a small town in North Carolina, I was introduced to another New Year's Eve food, chow chow. This is a sometimes spicy relish made with tomatoes and peppers (http://en.wikipedia.org/wiki/Chow-chow ). Man, that was some good stuff. When I married into my husband's family, I inherited a recipe for a cookie they make every January 1st. Now I know greens represent green money, so hopefully these delicious brown chocolate cookies do not invite a year full of $hi+. I prefer to think of them as representing a sweet start to the year. I don't know. Either way, they are easy and awesomely delicious.

Raquel's Grandmother in Law's Delicious New Year Cookies

Heat 1 cup white sugar, 1/4 cup cocoa, 1/4 cup milk, and 5 large marshmallows in a medium saucepan over medium heat, stirring constantly, until boiling. Remove from heat.
Stir in 1/4 cup peanut butter, 1 tsp vanilla extract, 1/4 cup butter (half of a stick), and 2 cups quick cooking or old fashioned oats. Mix well.
Drop by tablespoonfuls onto wax paper. Allow to cool.

Enjoy!

So Sweet

2012-01-01T05:56:00.000-08:00

I never used to be a big crier. Maybe I need to up my Zoloft or maybe I have a hormonal imbalance. I'm not sure... but this story brought tears to my eyes.
http://mommyish.com/stuff/parents-get-insulin-pump-tattoos-to-support-diabetic-child-947/

Solid Gold

2011-12-15T17:17:00.000-08:00

I had an elderly female patient in PACU yesterday, who had just gotten a knee replacement. As she was being hooked up to the PACU monitors, her gown got a little sideways, briefly exposing her nether regions. We immediately covered her with a warm blanket as she burst out laughing. "Girls" she cackled "you best not show that to the crowd. It'll blind them. It is solid gold!"

Family in the Recovery Room

2011-11-16T06:46:00.000-08:00

Does your hospital allow family members to visit patients in the Recovery Room/PACU?

My hospital does, and some nurses really do not approve. It is all that I have ever known, so I am used to it. I absolutely think that parents of young children should be back there. Also when we have had confused or developmentally disabled adults in PACU, a familiar face and voice truly helped them calm down and relax. However, if a patient is asleep or we have not yet gotten their pain under control, I would rather wait to bring a family member back. What do you think?

Quote of the Day- Political Version

2011-11-10T05:11:00.000-08:00

I was talking to a cardiothoracic surgeon yesterday. He was discussing the controversy regarding presidential candidate Herman Cain and the several complaints of sexual harassment lodged against him. Bear in mind this is the surgeon who when he saw me dressed up for my interview with the PACU, told me that he would give me a glowing recommendation based on how I looked in my dress.
His take on the Cain/sexual harassment controversy:

"Well, I don't see what the big deal is. Now if the media was showing a picture of him with two naked strippers with his hands up both their twats....now that would get my attention."

I'll bet it would, Sir, I'll bet it would.

Happy Halloween to my Friends in Obstetrics

2011-10-26T04:50:00.000-07:00

A nurse friend sent me this

Calling All Dermatologists/ Dr. House Where Are You When I Need You?

2011-10-21T06:33:00.000-07:00

What is this stuff? I used to see rashes all day in ER and urgent care, but this is a new one. I first thought it was a ringworm, fungal type of thing, but I'm not sure that the mild antifungal cream did a whole lot. It has been on the legs, top of feet and now very prominently on the back. I finally took the little guy to the Nurse Practitioner, who was not sure what it was and prescribed a combination antifungal/steroid cream. The Medical Assistant who triaged us in the office was positive she knew what it was and it looked like she had been around a looong time and had seen a lot of kids, but the Nurse Practitioner would not commit to a Dx. The cream seemed to do the trick. He has has not had the cream applied for several days now, and the rash is still gone. Opinions?

Urology News

2011-09-17T17:49:00.000-07:00

Eel enters man's penis in spa treatment, is surgically removed

Ewww. That is so not my idea of a day at the spa. Can you imagine the urologist's response when informed of the patient's chief complaint?

Question of the Day

2011-09-10T09:13:00.000-07:00

This question was posed to me by a brand new nurse, but is something that I have also wondered about in the past.

"Why do so many Respiratory Therapists smoke?"

Any ideas?

Acronym of the Day

2011-08-07T17:29:00.000-07:00

Hospitals have an obsession with abbreviations and acronyms. Every hospital where I have worked or trained has had a list of unapproved abbreviations in order to facilitate patient safety. For example QD, used to state "once daily", could be mistaken for QID, which is "four times daily", or even OD, something to do with putting medicine in one of your eyes or some such thing. Somebody could theoretically get really discombobulated and give their patient their once a day med 4 times in their eye. Just kidding...hopefully that would not happen. But as you can see, that could get confusing, so writing out potentially misreadable stuff makes sense in that whole "do no harm" kind of way. In times of yore, before the list of forbidden abbreviations existed, patients actually did get harmed from such confusion. Now that that's taken care of, we just have to worry about gathering round the chart and taking a poll on what the doctor has actually scrawled out in his or her funky handwriting.
But I digress. Hospitals and the agencies that oversee them really do love to make up their own abbreviations and acronyms. Some examples:
SCIP=Surgical Care Improvement Plan
CAT=Crisis Assistance Team
PCAT (pronounced "pee-cat") =Pastoral Care Assistance Team
and so on.
Our latest at my hospital is "OAT", which stands for Organization, Attitude, Teamwork. Our management came up with this gem in response to patient dissatisfaction with staff attitudes, "communication between staff members", and "timely response to patient needs". In other words, our Press Gainey scores are in the toilet.
Our managers are running around like chickens with their heads cut off, trying desperately to improve our patient satisfaction scores. All of our managers have started threatening staff with discipline if they have any unsatisfied patients. There have been loud chewing outs in front of other staff, and now actual firings of some pretty good nurses, who for one reason or another did not measure up to their manager's personal definition of "OAT".
So, I have created a new acronym of my own. I call it VOMIT, to describe the latest panicked attempts by the higher ups to fix our staff and resurrect our scores. It stands for:
Violent Obnoxious Mean Intimidating Tactics

Do you like it? Should it be vicious instead of violent? I wasn't sure.

I Don't Remember this one from Religious Studies Class

2011-08-02T18:01:00.000-07:00

Each patient at my hospital has a demographic sheet in their chart. It lists their name, address, emergency contacts, etc.
Last week I glanced at a patient's demographic sheet and noticed an interesting detail.
His religion was listed as "Caucasian".

Ultra Cool

2011-07-26T18:12:00.000-07:00

You can take the nurse out of the ER, but sometimes you just can't take the ER out of the nurse. Check these out :
http://jalopnik.com/5823167/the-ten-coolest-ambulances/gallery/1

Green Tea?

2011-07-24T11:49:00.000-07:00

Last night our break room microwave had completely quit working. So, I ventured into the surgical waiting room to get some hot water for my tea. Some family members of a patient saw me and struck up a conversation. As I was heading back to work, they asked me what I was drinking. I told them that I was drinking green tea.
The woman literally turned up her nose at me. "Hmmph" she said and turned to her daughter "She looks like the kind of person who would drink green tea".

****What does that mean?****

A Family in Need

2011-07-23T06:45:00.000-07:00

Some friends of friends of mine are going through a very tough time. Their first baby was a big girl at 9.2 pounds. Her shoulder got stuck during delivery and caused her to have a prolonged, rough delivery. She had a lengthy resuscitation, including induced hypothermia. Madeline is responsive, but still in NICU, fighting for her little life. Her parents are by her side every day, so along with hospital costs, they are dealing with lost wages and their usual bills. At http://sommerfamilydonations.blogspot.com/ you can donate some money straight to her parents. 100 % of the money will go to them. I know most of you are probably solidly in the middle class like me, but even a couple of bucks would be most appreciated, I'm sure. If you are not able to donate financially please pray, chant, offer good thoughts, work on her aura, send good vibes, light a candle, whatever floats your boat. I can't even begin to imagine what this family is going through. You can read about Baby Maddie at the family's blog:
http://babymaddiebelle.blogspot.com/

Thank you!

Really, Sir?

2011-06-18T06:58:00.000-07:00

I did not realize that using a urinal was so complicated. My rather healthy young adult male patient assured me that he genuinely needed my assistance to urinate in the ubiquitous plastic container. He was not in any way paralyzed. He was not one of those males so obese that he needed help locating his penis. He simply wanted me to position and hold it in place while he used the urinal. That would be a no.
Of course he later used the urinal successfully all by himself.

Europe and the USA

2011-06-08T05:44:00.000-07:00

Apparently this photo is from 2004, long before I entered the blogosphere. So, bear with me if you have seen it before. I admit that I do eat fast food sometimes. Working 12 hour shifts and shuttling kids to activities sometimes makes the drive thru inevitable, but I can definitely appreciate the humor.

Good Times

2011-06-04T07:06:00.000-07:00

I was floated to the floor this week. This rarely happens, as I am an ER, Preop, and Recovery nurse with little floor experience. However, desperate times call for desperate measures, I guess, so off I went to take care of some inpatients.
A gentleman in his 80's a couple days out from neck surgery was having trouble urinating. I got an order to straight cath him, which I did. He put out about a liter of urine and was much more comfortable afterwards.
I returned a while later, asking him how he was doing. he informed me that he had been able to urinate on his own.
"Are you having burning when you urinate, Sir?" I asked him.
"No, Maam," he replied "and I can tell you I don't have VD."
"Well, that's good to know," I said
"But you know I had the clap once" he started reminiscing, smiling dreamily. "Actually I had it twice when I was in the army. Back in Japan, you know. Goop just started dripping everywhere. Come to think of it, I recall I had the clap three times. Those were some good times, I tell ya" .