Back to business

Working always makes things interesting. From my space near the front door of the Hotel, I see a lot.

This week, I've had a lot of visitors. Folks looking to learn stuff I can teach them, families learning about when and where they'll go when they go home. I've even gotten to plan some projects and pitch new ones that need resources. I feel like I'm going somewhere, even though I'm running.

My regular characters come see me. One rolls in and it's obvious he needs help. His leg is dangling. He's slumped a little more than usual. He tells me the new wheelchair is having issues. His headrest is messed up and his foot pad won't stay on the chair, so we have to carry it upstairs.

Thankfully, he didn't have one of those spasms, that to the uninitiated, look as if he could just fly right out of the wheelchair. If I had a dollar for every time he's frightened new staff, I'd be rich.

Nevertheless, I fix what I can, empty his leg bag, and get him to the motor pool, otherwise known as therapy, so the wheelchair specialists can fix him up, literally, and figuratively. One smiles and tells him she knows where the "real tools" are.

He follows along, and I leave, knowing I've done my warm handoff to the next discipline.

Now for more fun...FIM certification!

Stay tuned.

Here I go again

***Happy National Rehabilitation Week! ***

Life is distracting. Especially when you have lots of things going on at once. Teenage kid getting hormonal. People at work being uncivil. Weather being unusually warm. Such is my life in RehabLand.

I've been finding and cataloging some great articles I've run into about these subjects, so here are a few of them. Hope you enjoy! I am, since it's helping me to stay sane as I get ready for the last week of travel for this year (I hope!) I'm looking forward to more learning, sightseeing and a Philly cheese steak while I'm hanging out with a whole bunch of other rehab nurses from around the country.

It may be from July, but KevinMD never fails to deliver some compelling content from nurses. I have to say if I were going to put something together, I'd be anonymous, too. The truth hurts, but hopefully, more folks will learn from the examples given in this article.

While it's not health related, if you are a foodie, and you love fried chicken, like Dahey (it's a genetic thing) you won't want to miss this article on the best fried chicken in the US. I swear he's still alive because of it. Dahey was a regular many moons ago when he lived down the road from Hattie's first storefront.

Finally, in light of national rehab week, take it from a former rehabber himself (who I just met, along with his parents, on one of my trips recently), ASK. People in wheelchairs, in many cases, can talk and advocate for themselves. Don't be afraid to ask, or you too, might miss a golden opportunity. Thanks Charlie for reminding us.

Hope you enjoy your weekend wherever you are!

Signs of the end of summer

It was too good to last. Yes, summer is trying to escape here in RehabLand. It didn't even get to 90 degrees today, and for August, that's cool. The pools are still open (mostly on the weekends) but many are getting ready for the last weekend: Labor Day.

I escaped today as I usually do. I have to go on rounds at Washington, so if I'm not feeling adventurous, I just hop on a shuttle bus. The trip is short, so I don't see much. Standing outside is the part I like if the weather is nice: seeing the sun and soaking up some rays (even if I'm wearing heavy-duty sunscreen to avoid both cancer and wrinkles). Today was glorious. The potted plants aren't wilted and the flowers are blooming again as if it's spring.

The patients like this weather too. When you can convince your therapist to take you outside for a game, or to go wheeling around campus, you've won. We call it community integration and on days like today, it's a good thing.

Why? Because you learn how to get up and down curbs (and how to gauge where the water will be when it rains) and despite whatever illness or injury put you in a wheelchair, for the moment, you're free to hang out and be a lounge lizard. Don't worry, our patients get sunscreen too. Orders for sunscreen are harbingers of spring around the Hotel, just like the swallows coming back to Capistrano.

However, the shuttle trips never last. I'm always dropped off at the door to reality. And today, someone is waiting. Waiting for me, the resident expert, to help them solve one more problem, before they go off into the summery, yet cool sunshine.

I'll take it any day! Hope you enjoy every minute of gorgeous whenever it comes your way.

More later...

All I want for Christmas

Yes, it's a song, but it's chorus resounds in the Hotel.

On the floor, all most of our folks want is to go home for Christmas. As nice as it is in the Hotel with all the volunteers and goodies and Santa (we even offer some shopping), most people want to go home for Christmas.

The folks who have no one, or no real home that looks like Currier and Ives, however, want to stay with us. Someone to take care of you is a happy holiday for them.

Some folks want a diagnosis for an illness that just cropped up. One minute, you're healing up. The next, you're sick, sick, sick and no one seems to know why even after multiple consults.

My office mate and I are still awaiting things to do our job, namely window blinds. That HIPAA assuring privacy thing really is a big deal, Mr./Ms. Hospital Interior Design person. We cannot do all of our jobs without it. So we rearrange, we encroach, and we crash in other areas. This makes for some other unhappy coworkers, but we manage. 'Tis the price of improvement and remodeling the Hotel, we say.

However, my relative is asking for something big: an accessible neighborhood. One in which you can ambulate by walking, your walker or your electric wheelchair, without fear of being hit by cars on a busy street. And since it's not far from the Hotel, it matters to us, too.

The social media campaign began yesterday. The news story airs tonight.

It's a big Christmas wish, but one that really should come true. Somebody's life may depend on it.

Stay tuned...

Almost home

The office mate is at a conference. His/her previous office mates dropped off the rest of his/her stuff yesterday. Why people don't move EVERYTHING when they move is beyond me. I'm just surprised they haven't asked to change the locks yet.

We are still in a fishbowl with no window coverings (blinds, etc.) which means no patients in our treatment area. One of these days our interior design staff will get a clue.

I'm hoping that clue comes special delivery today.

The patients that pass do like coming in to look around. Most folks in wheelchairs can do a 360 in the space in front of our desks, which is nice.

It's nice to be almost home.

I see it every day - Lessons in life

When you work in a rehab center with spinal cord injury patients (SCI), you hear the themes in this opinion piece from the Wall Street Journal a lot.

Remember: just because someone is in a wheelchair and can't move much at all, doesn't mean their brain doesn't work (or their mouth).

Talk to the person in the wheelchair, not their companions. That is all.

Happy weekend wherever you may be.

The latest in the news

This is the etiquette edition (aka don't do this). Enjoy!

They've got it right...and funny
Top 10 things not to say to someone in a wheelchair is a great article from the good folks at the Shepherd Center in Atlanta.

Not exactly a funeral in a stadium, but...
Don't take selfies at a funeral is the point of this Mashable post.

Don't emit noxious fumes
In the ongoing saga, Huy Fong Foods, manufacturers of the famous "Rooster" sriracha sauce have halted shipments.

Not necessarily a no-no anymore...
In the old days, no one in their right mind would bring their dog to the hospital. This AJN article talks about how your pet can help you just by visiting.

Things not to do as a nurse

Yes, I got my quarterly newsletter from RehabLand Board of Nursing, and yes, they do have a fine list of things not to do if you want to keep your license to practice.

Some of them were (are) frankly pretty scary, and I only wonder how long they went on before they were reported.

 1. Patient in wheelchair wants to go to bed (common Hotel scenario) and comes to nurses station.

Normal nurse: talks to the patient and then assists the patient to bed.
Our nurse: pushes patient forcibly out of the nurses' station and give a Haldol shot where the needle gets stuck in the patient. License suspended.

2. Nurse gets a tax return and 'forgets' to pay the state taxes.

Normal nurse: gets the taxes paid.
Our nurse: doesn't bother, so license is suspended.

3. Nurse is asked yes or no questions re: felony history.

Normal nurse: knows better than to do that. Nurses are one of the most trusted health professionals for a reason.
Our nurse: just fibs, gets found out, and gets license suspended

4. Nurse takes patient into a video monitored room in ER and examines his "groin pain"

Normal nurse: takes information and completes assessment.
Our nurse: fondles, kisses the patient, compliments his eyes and shares personal details. After this performance, our nurse is put on probation for two years.

And finally, for another technology related story:

5. Nurse remotely monitors patients as part of his/her job.

Normal nurse: does work, makes phone calls to patients, providers and case managers.
Our nurse: doesn't do any of those things for over a month and fabricates documentation,and gets license suspended.

Wild, wooly, and can we join you

Wild would have been an appropriate description of part of my day. One of the patients grabbed a trapeze and threw himself into his bed a la Tarzan. All I had to do was maneuver the feet and park the wheelchair.

Wooly described the outerwear I was wearing. Damp and dreary, but I'm not complaining. A few of our folks at the Hotel hail from areas being blanketed by the latest round of snow. In a couple of towns, they've had so much snow in the last week that roofs are collapsing.

And while the first round of inspectors came and quizzed us, our program was one of the stars of the show here at Hotel Rehab. They love the SU work. They want more of it.

Now just give us what we need: a backup so if I ever win that lottery, someone has a clue as to what is going on.

It would be nice! So so nice! A nurse can dream...stay tuned.

All on a Monday

You know you're going to have a day when...

1. The first two things you learn when you come to work is that one coworker and one relative of a coworker died over the weekend.

2. The wheelchair you've been waiting for never shows up. Paging therapy, purchasing, anyone who can get you wheels.

3. The crazy MD you talked to as you were walking out the door Friday sent you a cheery e-mail. Why am I having this Cruella DeVil vision when I think about that phone conversation?

4. Your supposedly "clean" office is so dusty, you may just have to go back to the allergist.

But things get better...really.

1. You get a guy who's been at your place for two weeks out of bed. "C'mon, I need your help." works a lot...I guess if you're a lonely guy who feels sorry for the nutty clinic nurse who can fling him on his stretcher with the best of them.

2. You and your office mates stage the latest potluck to scare away culinary boredom at the hospital cafe. How about a nice salami, mortadella and some coppa with that melon....yum!

At least, I'll get to do some more fun stuff later this week. Can't wait...stay tuned.

You know it's Monday when...

"It's a cruel, crazy, beautiful world./Every day you wake up/I hope it's a blue, blue sky." --Johnny Clegg

1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.

And in between all that, I had 1) other patients and 2) lots of documentation to do.

So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!

Stay tuned...

Change up

Here I thought, at the beginning of the week that I would have to work day shift for a while and lo and behold the boss switches my schedule around.

So working half in one shift, and half in another, I got to see some crazy stuff I don't normally see.

We occasionally have discharging patients who don't want to go home. We had one this week. This patient tried to think up every excuse in the book. It doesn't help it if the patient also has psychiatric issues and is not only anxious, but getting manic.

Psychiatrist, psychologist, and MD get patient a nice dose of something especially calming for the road. Nevertheless, the patient gets halfway home and calls to say, "I need to come back." MD tells transportation to take patient to nearest emergency room if things get crazy.

Another patient gets  in his wheelchair with snacks and a soda and proceeds to roll his chair off a wheelchair ramp in front of the Hotel, into the curb and somehow flip the chair. Thankfully, he couldn't go too far away. We have no idea why or how he did it. Called our docs, called the on-call doc, called the super. Patient gets the all clear. Lots and lots of fun paperwork to do for the charge nurse.

Another anxiety attack was averted when Mr. Z's nurse finally found his soda and snacks in his room. I don't think he could handle losing those items, which would have been worse than breaking his leg!

Stay tuned...we'll see what shift I work next!

Shake it up

I shook up the assignments when I worked last. I'm sure I'll hear about it again for ages. Why, you ask? I needed to get things done quickly once I arrived, so I did the assignment at home. I did not account for the people who worked the weekend, just as the boss regularly does.

Everyone did get  a reasonable assignment, though. I balanced every one's patients so no one had anything impossible. As the leader, I had the lightest assignment, because  I got the assignment to be the troubleshooter for everyone. Thankfully, the day was steady and not crazy. Our on-call doc kept me busy, when patients weren't thinking of some things for me to do.

Here's a list of some of the oddball items for the day:

1. One patient was doubled over in his chair and discovered by our chief when he was going to the elevator. Said patient was helped up, then got an order that he needed a strap to get up. He begged me to find something. I looked and looked all over the unit and I finally found one...in my car (I use it with a couple of elderly relatives I occasionally transport.)

He thanked me with a large piece of chocolate cake his wife brought him from one of the local premium bakeries. Yum!

2. Since our doc saw him doubled over, he figured he might need some labs. I drew those, then put in an IV after our super nurse, Mike, the old ICU nurse couldn't get him. Turns out this patient has a secret. His hand veins are the best...and hurt the least. I got one in his hand on the first stick (because couldn't get one in the one of the several monsters on his upper arms).

3. And finally, one patient had an urgent request: he wanted a backgammon board. I scoured the games section of the rec room and didn't find one. I did find him some dominoes, and left a message for the  rec therapy people so they can fulfill his "urgent" request  when they come back.

Only time will tell how the rest of the week goes, so stay tuned!

Down for the count?

Mr. S. got discharged recently. He told people that "two ladies jumped on my chair" and now it won't do anything. He claims the ladies "broke it". Mr. S. also tells a patient or two (via phone call and one, Mr. Chatty relays info to us) that he's sitting in his shower chair on his porch waiting for his neighbor to fix his chair. Our wheelchair specialist is not amused.

Oh, the heave ho going on at the Hotel is getting better. They've fixed us up with top-of-the-line ceiling lifts. The renovation's coming, but, in the interests of safety, and the fact that they've already spent the money, the Powers That Be deigned we get them. It's about freaking time. Who else moves more patients than us? Only one other rehab is in our system, and they had lifts way before us. To top it off, 95% of their people walk, even the amputees.

So I'm not sure if all the excitement of the new power equipment or if it's just the weather, but my back is acting up. So much that it warrants a trip to Dr.B to figure out what's up. I don't really want to be out of commission, but I really don't want to end up really injured either.

Stay tuned...

If you're bored...

And you're on our unit, you just might...

1. Cut your G-tube end off, because it was way too short anyway. What does Mr. Snip win, Vanna? Why a free trip to the ED, Pat!

Yes, it really is not RN scope of practice to float in a Foley instead, Mr. GI intern. That's your job to do it...or not, since you are on call for that specialty service.

2. Fall out of your wheelchair and require stitches. Yes, another trip to the ED and lots of incident report paperwork.

3. Tell your nurse on the daily health and welfare search, that yes, you do not have any more of a particular substance because you ate it. And no, you did not have any brownie crumbs on your tray.

It's not a full moon yet, but  it seems like it is! Stay tuned for more fun updates from the luxurious Hotel Rehab.

What do you think?

Patient X comes in doubled over for a visit to the SU, with wifey in tow. (She was so sweet and found a wheelchair).

Patient has full set of vitals suggesting he was seriously in pain (high BP, heart rate, etc.) He's consistently doubled over no matter what you do. Doc takes him and works him up. Basically, he's got the back from hell and needs neurosurgery, but at Madison, you only get it on the schedule. Our doc's suggestion: take Patient X to ER at Washington, our sister hospital. Wifey listens and away he goes.

Twenty minutes later, patient shows up at ER, vitals taken, still looks the same.

Another twenty minutes later, ER docs discharge Mr. X. Doc notices in the notes, he got his Dilaudid and was on his way.

It just makes me scratch my head...

Things sure look different up here...

That could have been the story of my day hanging in the Sister Unit.

In order to protect the guilty and the innocent, I'll present these out of order.

1. When you get a warning (as we do via our system) that a patient can be violent, you get a little worried. So glad I didn't know about that until AFTER I walked this guy here and there (because I had no place to go for him) and I got him to the doctor in the office with the panic buttons.

It became more ironic when the Doc managed to get him to agree to a treatment that can be quite painful. Thankfully, he was lying prone and I was out of reach. The doc was not, but all went well and the patient was happy with us.

2. No, the housekeepers aren't just happy people strolling around. They are strolling that way in violation of policy with their earbuds in jamming to whatever tune strikes them. And no, just shaking your head and smiling is not going to get me to tell you what you want while you bop your head to the tunes, buddy.

3. Yes, no really means no when the treatment team asks you if you've smoked with Mary Jane in the last month, even if it did help your spasms. Saying no and your pee says yes gets you thrown out of that rehab program. Better luck next time!

4. Finally, I got to redirect a lost patient to the elevator, then to his room. At first when the trainer and I came upon him in the hallway, I didn't recognize him. Then I realized he was one of the patients from my unit at the Hotel. Some people really do look different when they're up in their wheelchairs rolling around!

Stay tuned...tomorrow it's run, run, run as the procedures and exams rule the schedule. It'll be a fun day.

Can I just have one more thing?

One more thing to give me a headache
My sick brother repeating over and over and over that he wants to come home every time I go visit.  I need a Tylenol stat, please, with a coffee chaser!

One more thing to make my feet hurt
Dodging wheelchairs and dodging the wheel that fell off a guy's wheelchair as I was walking out the door today. We got it back on (with some assistance from two bystanders). Oh, "that's where that screw came from!" Mr. X assured me that the screw would be put in at home, since he knew exactly where it was.

One more thing that makes me go "Hmm..."
Why, oh why, do the docs tell Patient X, he/she can be up "as tolerated" and never bother to write the order? I document it over and over and over again, in my notes, of course, but my colleagues on other shifts don't really believe it if they don't see an order. And the way some of our docs act some days, it doesn't surprise me.

One more office visit for Bubba's strep throat...
And I will have spent over $100 for treatment and visits. Now if they made the kids' copay like last year, the antibiotic would have been the most expensive thing lately. Nothing like cost sharing. Note to self: save more in flexible spending account next year!

One more this...
And one more that. I'm not a big lemon fan, but these are the bomb as J. one of our nurses says. The ginger ones aren't bad, either.

And finally, one more that...
A nice cool glass of limeade, and I'm off to bed.

Stay tuned. Something's always happening around the Hotel...

Please forgive me...

Jeff Foxworthy. I'm only doing this post, 'cause Auntie sent me a funny e-mail you did.

You might be coming to stay for a long time at Hotel Madison if....

...you broke your limbs falling out of your wheelchair when transferring unattended.

...a drug deal went bad and you broke your arm when it was shot...and you didn't like that hospital where the ambulance took you, 'cause they're not as nice as we are.

...your doc told you "Oh, it's just a two day annual checkup. We're not going to do anything about that hole in your butt." and then changed his/her mind when our specialist showed up and said you were a candidate for a new, experimental repair.

...you have that insurance that pays you to camp out with us. Why work?

...you just like us so much, you try your hardest to get sick to come and see us. Every time the doc's in the room, you hyperventilate.

NOTE: I have embellished on the scenarios here, but at least 75% of these excuses are used to get an extended stay at our Hotel.

I wish I were joking...more later.

Ironies

I was driving down the road the other day and saw this license plate on a BMW:

BM-ING

Oh, the rehab nurse in me was just laughing out loud...if this man only knew how this would be received on my unit. Many punny comments would be exchanged and probably no one would want to ride in that car!

I'm coming up on my anniversary as a nurse and I keep thinking about some of the things that have happened to me since I've become a nurse.

1. I'm not too afraid of bodily fluids, but vomit gets me. Everything else--nasty, draining wounds, poop, etc., rarely faze me. It's that rascally vomit that is my Kryptonite. I go to that happy place really quickly when people vomit, or I'd be going to Emesisland with them!

2. I've learned to like gloves. It never bothered me if a foodservice person wasn't wearing gloves before, but it really does now.

3. I like teaching. In rehab nursing, we do a lot of this, and I've developed my own internal scripts, depending on the subject. One of these days, we ought to have a Rehab Nurse Learning Channel, tape our delivery of the educational topics and let patients watch on a patient channel, just like public access on cable.

4. I'm now fluent in several types of wheelchair drive systems. At least, I don't crash as much as I used to when taking them to the charging station. (Maintenance frowns on holes in the walls caused by staff).

5. I've always thought I was pretty resourceful, but I'm learning even more tricks. One of my recent patients, a quad with shoulder mobility, figured out how to use his rolled up washcloth (for his hand) to scratch his nose. It was great, but it kept falling out, so I used Kerlix and tape to attach it to his hand without gumming him all up. It worked great. At least it keeps him occupied enough, so he doesn't bug us ringing the call light to come scratch his nose!