Thursday, October 26, 2006

A moving post

Remember back in the day, when grandma had to have her prune juice and grandpa swore by his Colon Blow? Simple dietary adjustments would make your day, well, more regular.
I received a frantic call from my parents, who were more than a little freaked out by mom's new prescription for m!ralax. "Julie!" they said. "It's made out of plastic!"
Yes, the container is shatterproof, I assured them.
"No, you don't understand! Polyethylene glycol! That's plastic!"
Followed by a five-minute tirade about how they didn't think that drinking a toxic substance would help matters all that much, and if it really was recommended, couldn't she just gnaw on some Tupperware or something?
I vehemently hated chemistry, so with my meager body of knowledge, I expressed a doubt that they were, indeed, about to ingest plastic. At least not in it's final form, that is. Besides, I've read that my all-time favorite drink ever carries PEG in its ingredient list.
(I love you, Dr. Pepper!)
So it was with great interest that my sleuthing led to learning all about polymers and polyethers, and the miracle of lubes and G0lytely. I feel well informed and light of spirit.
Mom, may the force be with you.

I don't wanna

What do you do with a patient who is refusing select portions of their treatment? You push, and plead, and bargain. You explain, educate, bribe and *sometimes* just go ahead and do it amid their complaints. It's for their own good, you rationalize. Depending on the patient's mental status, health condition, and nature of the care they are hesitant to participate in, you strive to do "what's best", even if they don't immediately agree.
So it goes with the protagonist in my current saga.
85 yo well nourished white female who looks to be of stated age. Health history includes HTN, CHF, CAD, and numerous fx including bilat wrists, right clavicle x2, and compression fractures of thoracic, lumbar and sacral regions. Recent ORIF of right femur, and currently in a sling for management of right clavicle (3rd fx).
Will she wear her Kendalls? No. "They hurt." For whatever reason, they opted for ace wraps instead of TEDs, and more often than not they are too loose to do any good.
Does she do her incentive spirometry? No. Partly because "It's too hard", and mostly because she can't coordinate inhaling instead of exhaling on the mouthpiece. She has a weak, non-productive cough.
Four days ago I playfully tweaked her toes to check for blanching. She yelped in pain. I took a good look at her feet. Horribly edematous (chronic), I didn't even check for pitting. No discoloration present, but her RLE was notably warmer than her left. Incision site looks great. Minimal discomfort up there. I attempted to palp a pedal pulse - poorly. She could not bear to have me move that leg. I passed it on to the staff. I told her daughter, who looked at me blankly. "She needs to wear those compression stockings," I stressed. "And teach her how to suck air out of that contraption!" Well, she told me, mom was refusing. She's a grown woman, we can't FORCE her to do anything, she continued. "Like hell", I thought.
Somehow, I'm the only one who is complying with the doctors' orders. Even her nurses are letting her fall by the wayside, I assume because it is easier than arguing. WTF?
Am I wrong? I mean, she's not actively fighting the anti-DVT measures (and she is on Lovenox) - she just says "No" and then bitches about it until the other caregivers give in and let her have her way. I'm not meaning to imply I'm the "only one" who does anything the right way, but my word, people... there are protocols to follow, and her minor discomfort now will be a fond memory when her condition accelerates to ICU. Is it unethical to force compliance on a patient? What if it is your own family? Does that cross the line from professional to personal measures?
She goes today for non-invasives. Followed by a CT, if I'm as good at predicting outcomes as I like to believe. And I hope I am wrong, this time.

Tuesday, October 24, 2006

Press This

Ahhh.... those adorable Press Ganey surveys. Usually we only hear about the things that need fixin', but apparently, I made a lasting impression on someone recently. He said I was incredibly helpful and informative during his mother's stay, and I deserved an A++. Double plus, people... hotdamn!
This, from a week when I felt so insanely customer-UNfriendly it would make you weep. If I had to defuse one.more.situation regarding misplaced clothing or why our free-range patients are allowed to wander into daddy's room instead of being tied down... well... all I can say is the census is full and there is no room for me in the program at the present time. And, yes, Mrs. Smith, you mother is still screaming, and please feel free to call me in another hour "just to check".
So, a little housekeeping. Mother-in-law spent a lovely 2 weeks in our grand hotel's ortho unit, and as of today, was discharged to a LTC centre with a rehabilitation programme that promises to have her up and moving in no time. Sister-in-law has instructed me to "be the bad guy" and keep them on their toes (pun!) so that she doesn't go the way of many before her. Nice. Because there's nothing more than I'd like to do after a string of 12 hour night shifts than to sit around the nursing home pestering the staff. Oh, but I'm so qualified! You're right. My bad.

Up next: a shiny happy post about something I most assuredly will be making up. ::grin::

Tuesday, October 10, 2006


Just a heads up for all those sure to miss me... ::grin::
My 84 year old mother-on-law "fell and broke her hip" at some point today; I am told she is still in the ER awaiting a bed, but she will be visiting the OR in the AM, PDQ.
Anyway, as luck would have it, I'm burning the midnight oil this week, so I should have ample opportunity to visit and meddle and interfere PRN. I'll become one of those family members that make me cringe. Yay, me!
As witty as I am trying to be about it, I know all too well the unfavorable developments something like this tends to carry. Our sizeable, competent, high-dollar and highly-skilled facility is a good place for her care, but there's only so much anyone can do for someone in her age bracket and with her health status.
Add to this my 57 year old friend with SCLC that has metastisized to her right femur and is enduring chemo at this time... well, I'm feeling a little dark and dreary.
I'll be back when I need to unload.

Monday, October 09, 2006


And yet we imagine still
Change love life
Piece of peace
Of mind

October 9, 1940
December 8, 1980

Saturday, October 07, 2006

Torment = HTML

Do I look like a web designer?
No! But my new friend over there is. Heeheehee.
A special thanks to At Your Cervix for the idea. Yes, okay, I totally stole it from her.
Her monkey boy is awfully darn cute, but in the spirit of All Hallow's Eve, I figured I might as well jump on the Puca and get all creepy and stuff.
Spent hours tonight trying to get my sidebar to show where it is supposed to. Had to tweak some margins, and so on. But isn't she CUTE? She'll even eat the fly. Play with her!
Oh, by the way, no. I don't have a life. How sad is that?

Friday, October 06, 2006


As a teenager, he used to beat his girlfriends. At 45, he drugged a cat then beat it to death with a shovel. His wife is very controlling and condescending. She is embarrassed that he sought help for his depression. She calls him "weak", and "avoiding the real world". Their son, a podiatrist, lives several states away. They are very proud of him, though he is so busy and so important, that he finds it difficult to visit. Their daughter is "a disgrace" and they are raising two of her children. Over several days he began to unearth long-buried guilts on a variety of topics. His wife was shocked, she had no idea what a "sick and twisted" man she was married to. She had tried so hard to mold him into the perfect citizen and she once considered him to be "respectable". Now, her visits even make me uncomfortable. I wonder what his relationship with his mother was like...

Wednesday, October 04, 2006

I told you I was sick

... that's what I want on my headstone.
One of the fun things of being a nurse is you get to imagine every single symptom as a precursor to some fantastical malady that you've learned about. Or, to be fair, potentially exposed to. I have an amazing immunity, so unless I come across monkey pox sometime soon I'll just continue to imagine my gas is probably ovarian torsion or that next headache surely is an aneurysm. And of course, I'll continue to work right through it. We're short-staffed as it is!

Mother Jones tagged me. This meme asks you to name the five songs you'd like played at your funeral. I'm going to resist the urge to use "Had a Bad Day" as an example. Too easy. ::grin::
But I honestly can't trim it down to "just" five songs. Call me extravagant, but whatever.
So here goes, in no particular order:

Take it to the limit - The Eagles

One More Day - Diamond Rio

Second Hand News - Fleetwood Mac

The Dance - Garth Brooks

Wish You Were Here - Pink Floyd

Strawberry Fields Forever - The Beatles

Freebird - Lynyrd Skynyrd

I really don't know who to tag; I think everyone in my little corner has done this already!
If you haven't been tagged, consider yourself "it"!

Tuesday, October 03, 2006

Its not easy being green

Bambi. Newbie. What's another term for those warm and fuzzy interns? I mean no disrespect, honestly. But they're so cute!
June brought us a new batch of 'em from the family practice program. Plugging a post from Dr. A., I will admit that I do appreciate the family docs for many reasons. It is true, not everyone can know something about everything, and while a specialist is necessary at times, the down-and-dirty basics are still there.
What I find a entertaining is that the same dude who can manage a K+ of 6.7 with kayexalate, EKGs, O2, and IV push insulin with D5 50 without breaking a sweat - yes, this happened on our non-monitored unit - is the same guy who is hesitant to order an antifungal cream for yeasty skinfolds.
Early the other morning, Dr. Dearest comes to see his patient. I brought the gloves.
He does his physical assessment, tries to talk to her about how she is feeling, and generally ignores me. He mentions a few orders he will be writing, and I ask him if he would mind tossing in some nizoral lotion for her groin and abdominal folds. He wanted me to get her in to bed so he could see it. It happens every time, and each time I hope like crazy that it won't. This is why I brought the gloves. He looks interested, and I can sense the wheels turning in his mind. But does he write it, in the end? No! Mama Doc will be rounding with the whole group later in the day; he'd be back. At the end of their visit, I mention the skinfunk again. He says he examined it earlier. And? Mama Doc asked for his assessment. She said it sounded fungal. The patient is a morbidly obese diabetic. What is your plan? He writes for lotrimin cream. I ask if it can be a lotion, due to the area that needed coverage. He wrote for the nizoral lotion I previously requested. He shot me a look. Mama Doc smiles at me. It will be a long year.
I know docs have this status thing and granting requests from nurses might seem like we're undermining them, but really we're not. You can call it evidence-based practice, experience, or just trying to save you some precious time. I'm sorry I stepped on your ego.
So, she's reviewing their progress notes on their assignments, and periodically would quiz them.
And what are the indications for Abilify? How does the efficacy compare with the cost? Are there alternatives that might be available? Complements? What are the risks associated with antipsychotic drug therapy in the demented population?
Good times. Good times.
The PA students though - what a fun bunch those wacky kids are! I look forward to sharing counter space (and a phone) during dictation. Seriously though, this one guy looks like Doogie. I was listening to him the other day, and asked where he was from, (his accent seemed a bit weird). Utah, he tells me. He goes on to explain how he tends to pick up other people's accents, and he doesn't know why. I can empathize, being from Oklahoma, and living in Virginia for a decade, I can revert back to a southern drawl quite easily. My family used to think it was cute when we'd be visiting family up north and I'd pick up a slightly Canadian intonation. Back to Doogie. I asked him if he was from New Delhi, Utah. He laughed. Dr. Patel laughed. As time rolls on though, I find it distracting and strange. He got to do a rectal swab today though, so it all works out in the end. :-)

PS - this is one of those irreverent posts that someone might find offensive. All in a day's work, I say. All in a day's work. Lighten up, save the professionalism for the paycheck. Relax, and enjoy some snark. It's good for you.