That smell

You know it when you smell it. It's sickly, sweet almost, and nauseating. Once it permeates my nose, I'm done until I can get purge the remnants from my nostrils.

It's the smell of C-diff. I had a patient who had all the classic signs: loose stools, brown going to golden colored stool and the horrific smell. Rehab nurses are used to dealing with bowel, bladder and skin issues. This bowel problem made me want to run out in the arctic tundra that is our parking lot just to get away. And I was starving.

Thank goodness for bleach wipes and my handy, dandy air freshener. The air freshener permeated the room and made the smell go away.

Escaping and taking a nice, long walk helped, along with my lunch. It's amazing how therapeutic a lunch break and a walk at work can make you feel.

More to come...

In the news: Byproducts edition

One of my friends posted recently, "I just got hit by C-diff and VRE all at once." Yes, the gross part of being a nurse sometimes stands out more than others.

Note to new nurses: always know where you can get an extra set of scrubs. If you have a good sized locker, this is something you may want to stash, along with an extra pair of underwear and socks. It's good for those gross days, as well as for those times when you have local emergencies, due to snowstorms (as we did recently.)

Blow up
Yes, if you have enough methane in the form of gas and belches, you can indeed cause an explosion, as these folks in Germany found out recently (thank you BBC).

Tales from the ER
I really enjoyed this post from Florencenightnday about gross stuff in nursing. Yes, the trick is really: don't breathe through your nose (sometimes you have to limit how much you breathe through your mouth, too.)


Take a picture
Someone did here. Yes, it's gross, but this is the holy grail of rehab nursing.

Not a nurse, but worried about caregiving?
The Visiting Nurses of New York have this article for you. Don't worry. They won't gross you out too much. 

Last, but not least
Probably one of the mother of all poop posts you can find on the internet from jo at Head Nurse. Read the comments, too, they are valuable.

Amazing!

I read this in a note written by one of our critical care fellows for a patient who was transferred due to hypoxia. I'm sure all the pharmacists out there will be absolutely surprised by this new use for this drug (or maybe it's an off-label thing, since we are a teaching hospital).

metronidazole currently, added for hypoxia

And if that wasn't amazing enough, I'm not the only "mad as hell" person at the Hotel. Apparently, the good folks at Gallup are getting an earful in their polls, especially this one: Congress' job approval falls to 11%. It's about time.

But, I have to thank my old buddy, Steve, who found this jolly video below that every rehab nurse will love. If only all the toilets in the Hotel could have a bottle of this to kill the smell from some bowel programs.

Enjoy!

Now for something different...

No poop this time (I could go on ad nauseum, but I won't), but when I walked toward the inpatient unit at the Hotel recently, I was met with the most foul smell of urine. Not everyone agrees that it's a sign of UTI, which is true, but some urine definitely isn't just smelly, it's overpowering.

Cleaning it up didn't get rid of it, and neither did the myriad of air fresheners used by several staff members.

Some things I just don't miss when I'm not at work.

That is all. More to come...

Foul, smelly and otherwise crazy: update

I'm still finding words for what I saw and smelled recently.

We have a patient who's had an abdominal surgical procedure not once, not twice, but three times at the Hotel with us. He went to Washington, and I think every resident on that service must have worked on him/her. You'd think they'd get it right. Normally, this procedure is a slam dunk. It hasn't been lately for this patient.

Today, being a day after a holiday, is always a little weird. Things are done out of order since we have people still on vacation, meetings and bigwigs coming to visit. The unit goes from quiet one minute to absolute pandemonium all at once when you have 1) lunch trays showing up, 2) people moving around everywhere and 3) every motorized floor cleaner in our building rolling down the halls of the Hotel. It was not a pretty sight. I am so thankful I escaped with my feet unscathed.

The abdominal patient, seeing it was busy, and he/she didn't feel like moseying around early, decided to clean up after lunch. When I came back to pick up his/her stuff and dump a pan of water, I noticed the dressing and the towel he/she used was covered with tan drainage that seemed to ooze more fervently each time he/she pushed on the abdomen near the incision. By the time I ran to call the docs, he/she had an ABD pad soaking and a towel that was covered with lots of tan spots. MD and the trusty wound nurse were happy I called, because the stapled area of the incision did not seem to leak while they were in the room earlier.

For that dramatic, oozing display, said patient was whisked away to an emergency consult, where he/she was evaluated and then the specialists said, "Keep up the dressing changes. Bring him/her back next week and we'll re-evaluate it then."

The smelly: one of my patients with a newer colostomy can beat the nearest herd of cattle for methane production. If we could harness that gas, we could probably power the electric used in his/her TV everyday.

Finally, we just need a little crazy welcome back from a long holiday weekend...my brother's meds still aren't right. He's not happy, so he wins a trip to the unit where his psych actually is working now that he/she is not on vacation. I'm crossing my fingers that his regular doc can settle the issues once and for all.

And if that wasn't crazy enough, traveling partner and I are still dealing with the boss on various travel issues. Next time, I'll volunteer someone else to go to a conference with him instead.

More to come...stay tuned.

Nuggets for December 2

Here are a few things that have been topics of conversation on our unit and the things I've discovered about them on the internet. Enjoy!

Can you smell cancer?
This was one of the questions recently that folks were talking about since one of our nurses (actually a couple) has worked in oncology.

"So and so (fill in patient name here) is a real pain"
This patient-focused article from the University of Washington talks about the different types of pain in spinal cord injury (SCI) patients.

Stress and the holidays (an oldie but goodie)
It's not just the patients, but the nurses, too, get a little stressed out this time of year.

The smell of the week...

Sure it's summer and barbecue season. When I think of summer as a kid, I remember the smell of charcoal lighter fluid, Coppertone 4 sun lotion (no one called it sunscreen then), chlorine and the smell of food on the barbecue pit. Those smells still evoke fond memories for me.

This week, the smell is C. diff, as one of my assigned patients has this dreaded spore. It's really a hard to describe smell. To me, it's a flat, acrid smell that just seems to stick in your nose. It got so bad the other night, that I actually left the unit to sit outside in the breeze for a while. I had gowned, gloved and thoroughly washed my hands when I was done, but that smell (or the memory) hung around in my nose for a while. So far, this patient hasn't developed colitis, but we'll have to wait and see.

If you want more information on C. diff, check out these sites:
CDC
C diff project website (Netherlands)

On another smell note, totally unrelated to rehab nursing, check out Luscious Cargo. I got some perfume samples from them this week after I read a NY Times article about perfume. They even sent me a free one for Fracas, which is a very interesting scent.

Their smells sure beat C. diff!

More later...two more shifts on evenings this week.