It's very easy to get attached to some of our patients. When I think about this topic, I hear all sorts of scenarios from my psychiatric nursing class, where we talked about why we like some patients more than others.
Some of them remind us of someone we liked, didn't like, was our neighbor, relative, or friend.
It's not confined to patients, either. Sometimes, we nurses, meet some incredible physicians and other staff in the hospital.
Our docs in the Hotel, while often quirky, are our doctors. So when one wins a major prize, we celebrate. She has been with the Hotel for almost her entire career. Other doctors just visit us, and while we're nice to them, we're not nearly as fond of them as we are of our own.
However, since I have been roaming around on behalf of the Hotel at our sister unit, I've met a lot of doctors I first learned about while reading notes. One of those docs was Dr. M.
Dr. M. was a surgeon at the Washington. We waited for him for a long time. The first specialist retired, they hired someone, then the other never showed up (got a better offer while awaiting information from our HR--the specialty is in demand). We had one doctor (on loan) but PrivateU called him back to work in their hospital (when he wasn't sitting outside the US awaiting his Green Card.)
After years of waiting (literally), Dr. M. came on board from oceans away. He was a jovial fellow for a surgeon. The patients really liked him. He was kind and down-to-earth. Many of our doctors liked him, because he had a phone number and answered the phone whenever possible when he was at his desk. He was also happy to answer any questions they had when they saw him (the infamous hallway consults). I got to help Dr. M. occasionally when he was on the sister unit, visiting folks after surgery. Dr. M. always seemed to be smiling. Eventually, Dr. M. had a real department with another surgeon and a nurse practitioner.
However, our happiness was short-lived. We got the news that Dr. M. died at home over the weekend. Arthur Schopenhauer said “Mostly it is loss which teaches us about the worth of things.”
The happy, smiling surgeon left us physically, but we'll never forget him or the good work he did for our rehab folks.
More later...
Showing posts with label specialists. Show all posts
Showing posts with label specialists. Show all posts
Wednesday, November 18, 2015
Tuesday, November 17, 2015
Critical thinking
Is critical thinking in nursing really dead?
Sometimes, I wonder if it died recently, because many of the nurses who work at the Hotel tell strange stories.
What would you think of a rehab unit where...
1. Nursing staff don't want to get patients up to therapy after lunch? They went all morning, they say.
2. Nurses want scheduled pain medications because (I'm quoting because they actually said this) "He has to ask for prn meds and he never does, so we can't give it to him."
Pain is a part of rehab, but not taking care of it, especially in folks with addiction history, is criminal. Nursing is about alleviating suffering and promoting wellness.
Hmmm...wonder what part of the pain assessment they missed? How about the first part where the nurse actually talks to the patient. If Mr. Z. tells me is pain in his legs is a 10 after his first rehab session, even though he's got his long-acting on board, guess what I'm doing?
That's right...looking for PRNs. If those aren't appropriate, how about ordered adjuvants like cremes, gels or patches? Or my personal favorite: doing the interdisciplinary thing and calling your PTs (or whoever has them) and getting some warm packs if this might help (since we don't have a towel warmer like Saintarama).
If his pain isn't resolved, then we should consult the pain specialist group that is right down the way. They do take consults.
My $0.02 on this rainy night.
Sometimes, I wonder if it died recently, because many of the nurses who work at the Hotel tell strange stories.
What would you think of a rehab unit where...
1. Nursing staff don't want to get patients up to therapy after lunch? They went all morning, they say.
2. Nurses want scheduled pain medications because (I'm quoting because they actually said this) "He has to ask for prn meds and he never does, so we can't give it to him."
Pain is a part of rehab, but not taking care of it, especially in folks with addiction history, is criminal. Nursing is about alleviating suffering and promoting wellness.
Hmmm...wonder what part of the pain assessment they missed? How about the first part where the nurse actually talks to the patient. If Mr. Z. tells me is pain in his legs is a 10 after his first rehab session, even though he's got his long-acting on board, guess what I'm doing?
That's right...looking for PRNs. If those aren't appropriate, how about ordered adjuvants like cremes, gels or patches? Or my personal favorite: doing the interdisciplinary thing and calling your PTs (or whoever has them) and getting some warm packs if this might help (since we don't have a towel warmer like Saintarama).
If his pain isn't resolved, then we should consult the pain specialist group that is right down the way. They do take consults.
My $0.02 on this rainy night.
Sunday, May 24, 2015
I've always wondered myself
This article from the Wall Street Journal made me drudge up thoughts about some of the Hotel patients and other surgeons.
One patient had a common ailment that we see at the Hotel. It is always has the potential to be dangerous, even when it doesn't appear to be. It hides in the body and while we see the disfiguring side in nursing, mostly pressure sores, it's an illness that often requires the participation of multiple disciplines, ranging from plastic surgery (our most common), infectious disease, orthopedics, and sometimes even hematology/oncology.
People want to know what will happen and when one particular doctor gave his take of the situation, they called him "Debbie Downer". I explained to the patient (and the relatives) that this is not to scare them, but to tell them the truth. Informed consent really is a good thing, and sometimes, I spend way more time talking to patients after they hear life-changing news, and they ask the what, where, and why questions. Often, they just don't want to believe that one doctor.
However, our surgeon wasn't the only one. He also consulted with orthopedics. The patient was offered a procedure that was not acceptable. The other option was two different procedures: a hemipelvectomy or a girdlestone, but the patient wouldn't consent to those, either.
Our surgeon took the patient to the OR, since he/she agreed to the odds. The odds were not on their side. There was no miracle. The procedure could not be completed. We are pretty much where we started.
Now we wait to see what happens. Some things are just not what they seem, so being informed is a very good thing.
One patient had a common ailment that we see at the Hotel. It is always has the potential to be dangerous, even when it doesn't appear to be. It hides in the body and while we see the disfiguring side in nursing, mostly pressure sores, it's an illness that often requires the participation of multiple disciplines, ranging from plastic surgery (our most common), infectious disease, orthopedics, and sometimes even hematology/oncology.
People want to know what will happen and when one particular doctor gave his take of the situation, they called him "Debbie Downer". I explained to the patient (and the relatives) that this is not to scare them, but to tell them the truth. Informed consent really is a good thing, and sometimes, I spend way more time talking to patients after they hear life-changing news, and they ask the what, where, and why questions. Often, they just don't want to believe that one doctor.
However, our surgeon wasn't the only one. He also consulted with orthopedics. The patient was offered a procedure that was not acceptable. The other option was two different procedures: a hemipelvectomy or a girdlestone, but the patient wouldn't consent to those, either.
Our surgeon took the patient to the OR, since he/she agreed to the odds. The odds were not on their side. There was no miracle. The procedure could not be completed. We are pretty much where we started.
Now we wait to see what happens. Some things are just not what they seem, so being informed is a very good thing.
Sunday, November 10, 2013
Gotta love the pharmacist
The Cynical Pharmacist, that is. I follow him on Facebook, and I enjoy many a rant, er, post about the vagaries of serving the public from behind the counter.
This post was there today (see below). Since I deal with specialists regularly in the SU, it was quite entertaining. Unfortunately, the infectious disease, renal and transplant folks were left out. Sorry docs! (I love you, but many folks never know you exist until they get superbugs, bad kidneys or need a liver).
CP, I am thankful you are here. Here in RehabLand, we love our pharmacy folks. They are the only ones with a sense of humor as macabre as ours.
Enjoy!
=======================================================================
Thanks to Shiraz for sharing...
The American Medical Association has weighed in on Obama's new health care package.
The Allergists were in favor of scratching it, but the Dermatologists advised not to make any rash moves.
The Gastroenterologists had sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.
Meanwhile, Obstetricians felt certain everyone was laboring under a misconception, while the Ophthalmologists considered the idea shortsighted.
Pathologists yelled, "Over my dead body!" while the Pediatricians said, "Oh, grow up!"
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
Surgeons decided to wash their hands of the whole thing and the Internists claimed it would indeed be a bitter pill to swallow.
The Plastic Surgeons opined that this proposal would "put a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
Anesthesiologists thought the entire idea was a gas, and those lofty Cardiologists didn't have the heart to say no.
In the end, the Proctologists won out, leaving the entire decision up to the assholes in Washington.
This post was there today (see below). Since I deal with specialists regularly in the SU, it was quite entertaining. Unfortunately, the infectious disease, renal and transplant folks were left out. Sorry docs! (I love you, but many folks never know you exist until they get superbugs, bad kidneys or need a liver).
CP, I am thankful you are here. Here in RehabLand, we love our pharmacy folks. They are the only ones with a sense of humor as macabre as ours.
Enjoy!
=======================================================================
Thanks to Shiraz for sharing...
The American Medical Association has weighed in on Obama's new health care package.
The Allergists were in favor of scratching it, but the Dermatologists advised not to make any rash moves.
The Gastroenterologists had sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve.
Meanwhile, Obstetricians felt certain everyone was laboring under a misconception, while the Ophthalmologists considered the idea shortsighted.
Pathologists yelled, "Over my dead body!" while the Pediatricians said, "Oh, grow up!"
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
Surgeons decided to wash their hands of the whole thing and the Internists claimed it would indeed be a bitter pill to swallow.
The Plastic Surgeons opined that this proposal would "put a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
Anesthesiologists thought the entire idea was a gas, and those lofty Cardiologists didn't have the heart to say no.
In the end, the Proctologists won out, leaving the entire decision up to the assholes in Washington.
Saturday, April 20, 2013
Peeling back the layers
While I'm not the one who waits to admit patients to the Hotel anymore, I have assessments to do for folks who end up in the SU, so I still visit. I knew this particular patient would be trouble from the start.
Mr. I. had a history from faraway. He was a complex character. I had fun trying to find his records but when I did, they told me two big things: mental illness and intractable pain. Many nurses, when they see this think of two words: drug seeker. Mr. I. had a life of ill repute, so certainly he must be addicted to those painkillers, one staff member told me matter of factly one day. He was also mentally ill.
I did my required assessment and found him pleasant and with his sister when I came to call. Mr. I was fine doing his assessment with the sister there. "Sure, she can be here. I tell her everything." I did my work and was on my way, thanking both of them. Mr. I had been estranged from his family for a long time due to the distance and his illness.
The course of his stay was usual. Patient caused trouble, psych was called, meds were changed, and the Caffeine free Diet Mountain Dew cans were thrown at staff. Empty, Mr. I told the security staff, when they called a surliness code one day. "I know a full can might hurt someone, so I'd never do that, but she (Nurse Suzy) made me mad." Nurse Suzy made him mad when his pain meds were late and he was in pain. Mr. I told everyone that he was in pain all the time and nothing worked. Mr. I also said he had pain for years. "I probably have terminal cancer." he told another nurse. "I've been reading about it on the internet."
Day after day, Mr. I still complained about this and that, and was finally consulted to the pain management doc, and he/she said to leave his pain meds alone. He/she didn't see any changes coming anytime soon, so it was best to leave them alone.
Well, change came soon enough. Mr. I complained, complained, and complained some more. The docs decided to give him big workup. We found out his one chronic problem wasn't the only thing causing his pain.
The workup found that Mr. I has cancer. Metastatic cancer, partly related to his chronic condition, but the rest they aren't sure of. The oncologist gently told him that they can't give him a realistic prognosis without one more test (that wouldn't be terribly invasive, but would answer his questions.) Mr. I said he wanted to know, so do the test.
It was a sad day recently when his sister showed up. I asked if she needed anything and she just looked up sadly and said, "I need to get I's things. He's going to hospice, instead of that assisted living place the social worker found." The nurses guided her to the room and one offered to help her. "I'm fine," she said. "I always knew something like this could happen. I just never thought it was true. Now I know."
I waited to see if there would be an emotional response, but she stoically packed his belongings and took the computer and clothes out of the room."I promised to be there for him this time, and now I've got my chance. I never thought it would happen because he was gone for so long."
She turned and with a look of calm said, "I'll take whatever time he's got to help. It's all I can do. I'm his sister after all."
Mr. I. had a history from faraway. He was a complex character. I had fun trying to find his records but when I did, they told me two big things: mental illness and intractable pain. Many nurses, when they see this think of two words: drug seeker. Mr. I. had a life of ill repute, so certainly he must be addicted to those painkillers, one staff member told me matter of factly one day. He was also mentally ill.
I did my required assessment and found him pleasant and with his sister when I came to call. Mr. I was fine doing his assessment with the sister there. "Sure, she can be here. I tell her everything." I did my work and was on my way, thanking both of them. Mr. I had been estranged from his family for a long time due to the distance and his illness.
The course of his stay was usual. Patient caused trouble, psych was called, meds were changed, and the Caffeine free Diet Mountain Dew cans were thrown at staff. Empty, Mr. I told the security staff, when they called a surliness code one day. "I know a full can might hurt someone, so I'd never do that, but she (Nurse Suzy) made me mad." Nurse Suzy made him mad when his pain meds were late and he was in pain. Mr. I told everyone that he was in pain all the time and nothing worked. Mr. I also said he had pain for years. "I probably have terminal cancer." he told another nurse. "I've been reading about it on the internet."
Day after day, Mr. I still complained about this and that, and was finally consulted to the pain management doc, and he/she said to leave his pain meds alone. He/she didn't see any changes coming anytime soon, so it was best to leave them alone.
Well, change came soon enough. Mr. I complained, complained, and complained some more. The docs decided to give him big workup. We found out his one chronic problem wasn't the only thing causing his pain.
The workup found that Mr. I has cancer. Metastatic cancer, partly related to his chronic condition, but the rest they aren't sure of. The oncologist gently told him that they can't give him a realistic prognosis without one more test (that wouldn't be terribly invasive, but would answer his questions.) Mr. I said he wanted to know, so do the test.
It was a sad day recently when his sister showed up. I asked if she needed anything and she just looked up sadly and said, "I need to get I's things. He's going to hospice, instead of that assisted living place the social worker found." The nurses guided her to the room and one offered to help her. "I'm fine," she said. "I always knew something like this could happen. I just never thought it was true. Now I know."
I waited to see if there would be an emotional response, but she stoically packed his belongings and took the computer and clothes out of the room."I promised to be there for him this time, and now I've got my chance. I never thought it would happen because he was gone for so long."
She turned and with a look of calm said, "I'll take whatever time he's got to help. It's all I can do. I'm his sister after all."
Friday, February 15, 2013
Field trip!
I am one of those people who loves to get out of the Hotel and roam. Even if it's only to the cafeteria on a nice day.
Today was different. I had meetings at Washington (aka the Mothership).Since Bubba and Dahey were roaming around on RehabLand Elementary's February vacation (why they give kids a five day weekend in February...), I had them drop me off there and pick me up when I was done.
I was there and had 3 meetings with people in four hours. It wasn't too terrible, because I had time in between.
First, I had to meet with Dr. C. He's a surgeon our chief wanted me to talk to about the SU. Nice. He was a character, still in his OR cap, as if he'd just come from a case. Dr. C. is about 5 feet tall. In reality, I think he just wore it, so patients would think he was busy. For a surgeon, he was interesting. He sat next to me and looked me square in the eye when he talked, very unlike any of the other surgeons we work with.
Next, my old super, Reg, took care of me when I needed a computer to finish my work between one of those meetings. It was fun. He gave me his office on the unit in the middle of an allied health open house. Respiratory therapists and therapists of all stripes were being interviewed everywhere on that end of the building that's normally not occupied.
I visited Dr. V. next. He and I worked at Saintarama Rehab. We got assigned to the same committee for that reason. He's smart, but not a subject matter expert on this project, so that's why I'm with him. I started having flashbacks to undergrad when he started talking about SWOT analysis and Professor Brothers saying, "RehabRN, what are the opportunities for Company X?" Just as long as I don't have to take accounting again, I'm okay.
Finally, I visited the last person on our chief's list. The urologist. Everyone's favorite person among the male patients. A positive evaluation from him gets you the ED drug of your choice, based on your diagnosis. His waiting room was crowded. I was just shocked that he took time out to talk to me, along with his nurse.
Although I left later than I wanted, the diversion was worthwhile. Washington's coffee bar in the lobby has some really wonderful brownies. Yes, I was supposed to give up sweets for Lent, but I distinctly recall the priest saying, "Don't give up something you're just going to start again when Lent is over."
On my honor, I will never EVER give up chocolate. End of story.
Have a great weekend wherever you are!
Today was different. I had meetings at Washington (aka the Mothership).Since Bubba and Dahey were roaming around on RehabLand Elementary's February vacation (why they give kids a five day weekend in February...), I had them drop me off there and pick me up when I was done.
I was there and had 3 meetings with people in four hours. It wasn't too terrible, because I had time in between.
First, I had to meet with Dr. C. He's a surgeon our chief wanted me to talk to about the SU. Nice. He was a character, still in his OR cap, as if he'd just come from a case. Dr. C. is about 5 feet tall. In reality, I think he just wore it, so patients would think he was busy. For a surgeon, he was interesting. He sat next to me and looked me square in the eye when he talked, very unlike any of the other surgeons we work with.
Next, my old super, Reg, took care of me when I needed a computer to finish my work between one of those meetings. It was fun. He gave me his office on the unit in the middle of an allied health open house. Respiratory therapists and therapists of all stripes were being interviewed everywhere on that end of the building that's normally not occupied.
I visited Dr. V. next. He and I worked at Saintarama Rehab. We got assigned to the same committee for that reason. He's smart, but not a subject matter expert on this project, so that's why I'm with him. I started having flashbacks to undergrad when he started talking about SWOT analysis and Professor Brothers saying, "RehabRN, what are the opportunities for Company X?" Just as long as I don't have to take accounting again, I'm okay.
Finally, I visited the last person on our chief's list. The urologist. Everyone's favorite person among the male patients. A positive evaluation from him gets you the ED drug of your choice, based on your diagnosis. His waiting room was crowded. I was just shocked that he took time out to talk to me, along with his nurse.
Although I left later than I wanted, the diversion was worthwhile. Washington's coffee bar in the lobby has some really wonderful brownies. Yes, I was supposed to give up sweets for Lent, but I distinctly recall the priest saying, "Don't give up something you're just going to start again when Lent is over."
On my honor, I will never EVER give up chocolate. End of story.
Have a great weekend wherever you are!
Monday, April 2, 2012
Monday madness, part 75
Maxim of the day: If it can go wrong, it will. Don't take it personally.
Oh, the joy of coming to work to hurry up and get things done since I'm going to be in training, have to get subs for my appointments, and have to get people at the office in Nashville (who want to talk to our specialists) all to come together in the same room at the same time. Specialty Doc is just picky about that kind of stuff!
Well, I get my subs lined up and I get a call from the training guy. His room is not really his room so training is cancelled. Wonder what the consultant is going to charge for that...and will I be able to make the replacement date. Ugh!
Next, I go to plug in a fancy-schmancy piece of equipment and find the specialty outlet has been damaged. Funny, it just worked last week. Score one for the movers, who obviously aren't careful. Expensive equipment 0, Idiot movers 1.
And what day wouldn't be complete without a head-case specialist ('cause it is his specialty) going all prima donna e-mailing people hither and yon for an appointment I won't even be able to attend, since I'll be out of town. Thank goodness I got him under control quickly. I don't want him to make my sub cry (he's been known to be cranky and mean.)
At least, the patients I had to deal with today were pleasant. Amen to that!
More to come...stay tuned.
Oh, the joy of coming to work to hurry up and get things done since I'm going to be in training, have to get subs for my appointments, and have to get people at the office in Nashville (who want to talk to our specialists) all to come together in the same room at the same time. Specialty Doc is just picky about that kind of stuff!
Well, I get my subs lined up and I get a call from the training guy. His room is not really his room so training is cancelled. Wonder what the consultant is going to charge for that...and will I be able to make the replacement date. Ugh!
Next, I go to plug in a fancy-schmancy piece of equipment and find the specialty outlet has been damaged. Funny, it just worked last week. Score one for the movers, who obviously aren't careful. Expensive equipment 0, Idiot movers 1.
And what day wouldn't be complete without a head-case specialist ('cause it is his specialty) going all prima donna e-mailing people hither and yon for an appointment I won't even be able to attend, since I'll be out of town. Thank goodness I got him under control quickly. I don't want him to make my sub cry (he's been known to be cranky and mean.)
At least, the patients I had to deal with today were pleasant. Amen to that!
More to come...stay tuned.
Thursday, October 20, 2011
It ain't Bob and Bing on the Road to Utopia, but..
All of these things happened to me on the road recently with the boss.
1. I was accused of drinking the last of the caffeinated coffee in the conference room. I drank decaf instead, and waited for the new stuff to arrive. "No, " I replied. "It ran out before I got there."
2. Boss almost choked. Thank goodness I didn't have to do the Heimlich on him/her.
3. Boss kept borrowing so many office supplies that my return flight seat mate said, "What are you going to have to do next? Make coffee?"
But it wasn't all terrible.
1. Boss held my spot in line to get on the plane as I desperately ran to Starbucks for a coffee and he/she declined one. (I was nice and offered, as I always do.)
2. Boss stood in the rain to get a cab.
3. Boss and I sat near each other in the conference and I didn't hide his/her pens once (although he/she "borrowed" my only notepad to take calls from people at the Hotel.) Yes, while the meeting was in progress. Boss also wrote remote orders on his/her laptop.
4. Boss complimented me on my knowledge in front of our work group, who had come from around the nation.
It is always interesting to watch
1. Specialists squirm when they don't understand something.
2. People getting in those inside comments, "We finally went out and got Nurse X a Queen's Square hammer for the clinic after that study." Thanks to Grumpy, I actually KNEW that one. (still have to find out what Boss's favorite is though...I'm guessing a Troemner)
Nevertheless, I survived. Boss, I'll miss you when you're gone the next time.
Just remember...I have pictures of you sleeping with your mouth wide open on the plane, proving, yet again, that you're still human like the rest of us.
Stay tuned...could be on the road again before you know it.
1. I was accused of drinking the last of the caffeinated coffee in the conference room. I drank decaf instead, and waited for the new stuff to arrive. "No, " I replied. "It ran out before I got there."
2. Boss almost choked. Thank goodness I didn't have to do the Heimlich on him/her.
3. Boss kept borrowing so many office supplies that my return flight seat mate said, "What are you going to have to do next? Make coffee?"
But it wasn't all terrible.
1. Boss held my spot in line to get on the plane as I desperately ran to Starbucks for a coffee and he/she declined one. (I was nice and offered, as I always do.)
2. Boss stood in the rain to get a cab.
3. Boss and I sat near each other in the conference and I didn't hide his/her pens once (although he/she "borrowed" my only notepad to take calls from people at the Hotel.) Yes, while the meeting was in progress. Boss also wrote remote orders on his/her laptop.
4. Boss complimented me on my knowledge in front of our work group, who had come from around the nation.
It is always interesting to watch
1. Specialists squirm when they don't understand something.
2. People getting in those inside comments, "We finally went out and got Nurse X a Queen's Square hammer for the clinic after that study." Thanks to Grumpy, I actually KNEW that one. (still have to find out what Boss's favorite is though...I'm guessing a Troemner)
Nevertheless, I survived. Boss, I'll miss you when you're gone the next time.
Just remember...I have pictures of you sleeping with your mouth wide open on the plane, proving, yet again, that you're still human like the rest of us.
Stay tuned...could be on the road again before you know it.
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