Ahh...take a breath...

It's been busy the last few days with my class finishing up. The paper has finally been turned in, I'm officially registered for next semester and my exam is over and I passed! Hooray!

Now the fun of the holidays begins. The halls of ye old snowflaked and hollied Hotel Rehab are full of people going hither and yon to therapy and the reservation agents just keep filling the rooms (since they don't work holidays, anyway!). The holidays are usually a slow period for us, but this year will not be the case. Lots of people are eagerly anticipating the annual holiday party, so we'll see what happens. Last year I missed it, because I got the pleasure of working. This year is different.

Since I'm off today, I'm maintaining the fleet, otherwise known as making sure my car is ready for winter and I'm jamming in my favorite coffeehouse with A Very Special Christmas. With all this global warming, we'll probably end up with several feet of snow or 60 degrees for Christmas. Nevertheless, I'll be ready in my trusty old car, which turns double digits next year.

More to come...stay tuned!

Nuggets for December 9

Good stuff below...enjoy!

Viral breast cancer video
If you haven't seen it, you gotta check out the Pink Glove Dance.

Fun stuff
Check out NeuroDojo and train your brain.

Forget Tiger Woods and all his girlies, I mean waitresses, for a while and check out this other important controversy with an older gal: The Sun-Maid Girl Makeover Sparks Controversy
The marketing dweeb in me just wants to know...did y'all do your research or what?

BTW I think the new, animated missy looks more like Penelope Cruz in a red bonnet than Julia Roberts! Whatcha think?

If you think your house or apartment is small, check out these digs in Manhattan. (from the NY Post).

Maybe we'll all get along at the holiday party...
In the spirit of the season, 12 things never to say to older or younger coworkers

And that's another edition of Nuggets...adios until later.

Not enough time

So many things to do:
Run errands on your day off.
Get your car repaired.
Do Christmas/holiday shopping.
Study for that test.
Finish that darned paper for class.

And I go to work and time goes in spurts--slowly and quickly. Slowly when you look at the clock and say, "I'm ready to go home" and it says you still have four hours. Quickly when you look at the calendar...another year has come and gone.

Time concerns wear on your patients, too. One guy is antsy to go home to be with his family at the holidays. One patient wants time to find out when they can fix his wheelchair so he can get out of bed, because without that fix, he's grounded.

For some, no matter what we do, there will not be enough time. Not enough time to spend with them because they are so anxious and confused that they forget when we tell them we'll come back to see them.

Not enough time for the patients with cancer. One is calm and at peace with his fate--the Sword of Damocles has hung over his head for a while longer than anyone expected and he just savors ever moment...even if it's drinking his supplements while watching wrestling on the big screen all by himself. "I don't feel too bad. This is great!"

Another has the meter running and it's speeding up before our very eyes. If we don't move fast enough, he/she will die with us, not in the hospice unit nearby, not with his family nearby. It wears on us all. "This is no place to die," the doc says with much chagrin.

Never enough time, so enjoy your every moment. Off I go to mine.

Stay tuned...

Remember, honor, teach

I'm working and reading my e-mail in between the final paper, but I couldn't not pass this one along. Thanks, sk!

Learn more about the Wreaths Across America project here which will decorate thousands of US veteran cemeteries this year.

MIA

Only temporarily...lots of stuff with school sandwiched in between work, baking and the holidays.

One more week and hopefully, one less dramatic psychiatric episode. One day, highway suicide (not our patient), the next, hostage standoff (not ours, either, but on campus). Those weren't the exciting things I was asking Santa for this year!

Guess in this full moon week, I'll be happy with sedate campers watching movies on the big screen in the dining room.

Stay tuned...more to come!

Nuggets for December 2

Today's nuggets are decidedly not healthcare related (okay, maybe one or two) nor holiday related, but they are interesting tidbits I thought I'd share.

Hope you enjoy!

Healthcare news

No, it's not Public Option, but the government (local and state) just may get involved in your medical procedure if you're visiting your friendly, neighborhood plastic surgeon. Gotta ask our regularly visiting specialist about this one of these days.

My boss would like this one

This recent BBC news article discusses the Bad Sex in Fiction awards (yes, there really is one).

If they won't read the legalese...

Maybe they'll read a cartoon, as the Madagascar government releases information about changes in their constitution in another fine BBC article.

In the spirit of the season

Having a bad day? Don't like surly customer service people? Check out this convenience store's answer to a new type of employee in Clearwater, Florida, and it's not a robot.

Heard on the unit

Patients, some of our coworkers, and even the boss, can say the darnedest things.

Scenario 1 -Maybe he just likes me

Patients in our meeting room (where the big screen is) watching the Turkey Day football.

Me: "Look at all those guys in front of the TV asleep watching football. Too much Thanksgiving dinner."
Boss: "And are you going to say something stereotypical about that?"
Me: "No, I'll just keep it to myself."
Boss: (with glint in his eye)"I'm sure it's just tearing you up."
Me: "Of course, it is." (smirking in reply)

Replies you don't expect

Patient 1 in a double room is a big born-again Christian who grates on his neighbor's nerves (Patient 2).
Patient 1 is watching a Christmas movie. We talk about what Ralphie wants for Christmas, and what the patient wanted for Christmas.
Patient 2, exasperated by Patient 1 in general, replies, "How about an assault rifle, anyone?"

Fun surprises

Some of our patients spend a long time with us with very few calls. One patient of mine has had the opposite problem. "I get more calls now than when I was at home. One guy from my unit, who I haven't seen in years just called me. He told me he has my dog tags."

This particular branch of the service is famous for posting listings of members of particular units on the internet and they have lots of their own bulletin boards. Someone got his family info from an internet post and called a relative who passed along his hospital phone number.

Add a dash of excitement

This was the week that was:

1. Assigned to the now reigning heaviest patient on the unit all week (the absolutely heaviest patient went home). Shoulders are aching. Patient is sweet, though. Nothing like the mean, foul one we just sent home (see previous).

2. Requested, asked nicely, e-mailed and queried directly to see if I would get some time off this week. Reluctantly, boss gave in. One of my coworkers opined, "it's just like nagging your husband to do stuff around the house."

3. For a dash of excitement, we had a drug bust this week. No, there is not supposed to be anyone named Mary Jane; although we do have a Mary or two on staff. (tongue firmly in cheek). Nice. So glad I missed that one. Glad security got the pleasure of search and destroy on that one.

4. Neuropsychologists stick up for the nurses in front of administration on several patient issues. Amen! It's about time. Maybe those regular team meetings (aka the bitch sessions) are working after all.

Change of Shift - Thanksgiving edition

Yes, Kim's slaving away...check out the latest edition of Change of Shift over at emergiblog.

Oh, let it be the day...

I get some work done on my paper.
I get a turkey for Thanksgiving.
I get a nap.
I get a few other things done.

And last but not least, let it be the day that we get rid of a few patients so the inn is not so full. We've been bursting at the seams lately, and with people on vacation, it gets a little crazy.

I'm just praying today the uber-pain in the arse, as one of my coworkers calls this patient, gets on the plane and gets out of Dodge. We certainly must have made it on Santa's good list for taking care of that one!

An anniversary

One of my patients reminded me what today was while I was working: JFK anniversary. Said patient actually met JFK while on an honor guard detail.

Nuggets for November 19

Theoretically, I'd like to post these weekly on the same day, but darn it, if something doesn't pop up and distract me!

Anyway, here are a few of the goodies I've been saving all week to share with you. Enjoy this pre-Thanksgiving feast! It's calorie-free!

News of note

Pregnancy outcomes good for MS patients (from www.reuters.com)
Some of my people are really going to like this one. Overall, MS seems to get better in a lot of women while pregnant.

On another MS note, I found this interesting blog called Fingolimod and Me by a woman who's participating in a drug trial for fingolimod, aka FTY720. I enjoyed the subtitle the most: A hypocondriac joins a clinical trial...

I wish I worked here

This NY Times article discusses a company with a no gossip policy: Workplace gossip? Keep it to yourself

Amen, sister!

HHS Secretary Kathleen Sebelius weighs in on the mammogram debate in this nursezone.com article.

Mystery resolved

I enjoy reading a good mystery novel now and again, but this story I recently read is not fiction:
Mystery of Bangladesh's mass arsenic poisoning solved. Let's hope fixing it will become a priority!

Goodies in the blogosphere

I really enjoy reading LaTonia Denise Wright. Who would think she could make legal discussions interesting...and downright funny? This nurse barrister surely can turn a phrase, and while the topic's a serious one, I enjoy the presentation. Check out her More Drama for your Mama post.

Ian from impactednurse.com has a great article on Mindfulness that's worth your time. I have to remind myself often to take care of myself for my patients, especially while working.

Finally, Mother Jones tells it like is in her Listen to your doctor, Uncle Sam post. Don't miss it!

When's my next vacation?

I started thinking that after a hard day of lifting the other day. I really enjoy my job, which I could think about at home, sitting on the couch, reading a book in between the work I assigned myself to do at home. Boy, moving is hard work!

The hotel at Madison is nearing capacity. We're running out of room. People are coming in because the holidays are popular. Lots of volunteers visit us and drop off goodies. Some of our regulars have this routine figured out pretty well.

On top of that, I'm finishing my grad class...slowly but surely. I'm hoping my funding for next semester doesn't go away before I can get it again. I'm just going to have to put juggling on the list of things I do...and not for fun. Nurses juggle a lot, anyway, due to the nature of the business, but the juggling right now is somewhat beyond my control. I guess I'll be happy to see if the balls return again to the air.

So many things, so little time. Am off to make the most of it right now. Stay tuned!

One down, one to go

One online course is complete. Hooray!

Now it's just wait and see for the other one. Lots and lots of stuff going on this weekend and then they idyll is broken. Back to work...

Nuggets for November 11

So many goodies, so little time. For those of you who take care of America's veterans and active service personnel, this one's for YOU! If you want to learn more about military nursing traditions, check out this great page at medi-smart.com for a list of varied websites, from oral histories of military nurses in Vietnam to other military nurse resources.

I still can't get over what happened at Fort Hood. One of my coworkers recently lived there. I am still thanking the Big Man for the civilian police officer who took down the shooter. I was working at Madison when I read Nurse Ratched's account of working with the shooter, which gave me chills as I read it aloud to a group of coworkers. I just cannot imagine...

Compassion fatigue is common among caregivers of all stripes. It saps you of the energy you need to do your job, take care of people and continue along in a healthy manner. Dr. Charles Figley has an older article about this very topic, with lots of references.

The holidays are coming and yes it's stressful. This article called Choosing Happiness in Our Lives revisited discusses how to deal with some topics that just might creep up with all those relatives coming to town.

One card

He opened it, and one line made the difference:

"Thank you for your service."

To all veterans today, I say thank you, too. Look around you, there are probably more veterans than you think. Some World War II, Korea, Vietnam, Iraq and Afghanistan, and the Cold War veterans, too, who stood watch, on the fronts of barriers and demilitarized zones, in the air, and in oceans deep, to keep us all safe.

Food, cooking and a little spice

Well, since we're getting out of barbecue season now on our unit, everyone's thinking about Thanksgiving. Some of our patients and nurses, however, are always thinking about food and things spicy.

Our dietician has so much fun with many of our patients, who, not unlike a lot of the general population have high BMIs. What does this mean? This means that dietary will talk to patients about adjusting their diets. Of course, most people don't like the "adjustment" part, which usually means they get less sugar and fat.

One of our high BMI guys has done better since he's arrived, but we joke that if you go talk to him, by the time you leave the room he'll be talking about food. Mr. X is a bon vivant who developed his talents in the finest kitchens before he came to us, so he's very discriminating. We don't have the best hospital food by far, but Mr. X can tell you what they do well and what they don't. Mr. X has even been nice enough to share some of his favorite recipes (including one similar to this one) with the nurses and whomever would like them. He's working on a gourmet dinner before he leaves, so I'll probably miss it while I'm slaving away here at the ranch.

Finally, one nurse has added some spice to the unit in a different way. Since we're expecting some terror patients soon, she decided to get some sage on the unit. K. is not really a new age kind of gal, but since she's seen people who have used sage on our unit in the past, she got some and purified our empty rooms just in case. Only time will tell if it actually worked...or we'll have to call the chaplains in for further consultation.

More later...

Falling leaves

I think of this song every time I go outside these days...

The falling leaves drift by the window
The autumn leaves of red and gold
I see your lips, the summer kisses
The sun-burned hands I used to hold

Since you went away the days grow long
And soon I'll hear old winter's song
But I miss you most of all my darling
When autumn leaves start to fall

It's that time of year here, and while the leaves were falling slowly and picturesquely the other day, the gusts have put piles of leaves everywhere. And as usual, the critters are running around near Madison. Deer leaping out all over the place, skunks on the move, and yes, the field mice are heading indoors whenever it gets chilly.

Madison is still the same. We're getting into the holidays. As a peon, I'm pretty much expecting to work every single solitary holiday. I'm already on the list for Thanksgiving. So we'll see how it all goes. We'll also be planning the vacations for next year soon, so I'll expect to get mine at whatever time the boss sees fit again this year, not when my family would like to take a vacation. I don't mind right now, though. I got lucky and managed to get a week everyone suddenly lusted over.

So while I'm meandering around this time on vacation, I'll be studying and doing some work around the house. And posting about a few interesting things I've encountered lately. And hopefully, I'll be jumping into a pile of leaves once in a while.

Stay tuned...

The three D's

Ah, things I do when I should be reading more of my homework...listening to three D's right about now...

Dan Fogelberg
Denys Lable (and a couple of friends...)
and last but not least,
Declan Masterson

A little pipe music never hurt anyone!

Stay tuned...will be back!

Fall weekend

It's so beautiful in our neck of the woods, even though the weather's been really weird for our part of the country. Most of our trees in the yard have turned red, yellow or orange. With all the wind, many of the leaves have fallen.

Bubba's had fun at the many Halloween parties he's attended. One more tonight and we're done! At least I can say we got our money's worth from his costume, which he picked out himself. He's quite the shopper--it was also on sale.

Dahey's driving again delivering goodies and swapping and trading hither and yon. Thankfully we have cellphones or I'd never know where he was.

And I'm here studying away before we start all the fun tonight. Should be an interesting weekend...stay tuned!

Run, jump, and play with scissors

That's been the story of my days, for weeks it seems.

Running...I do that all day long. And with the remodel, they plan on making my trip longer. We will have the entire building for our unit, so it will be a very long walk. I suppose this means they'll get those tracking devices again soon, for our own safety, of course.

Jumping...was what I did after I got all my notes written. If it wasn't someone coming in, it was someone going out to a test or procedure. One patient had a test and then was sent to acute to resolve an emergent issue. Yes, they do really happen that fast. Why no one noticed is beyond me. I've given up trying to figure out what other people think. My job is to think on my feet and call the cavalry when needed.

Playing with scissors...ah, the joys of teaching. I'm becoming the Queen of WoundVACs, promoted from Princess since the Queen has been on vacation this week. (We like to think we're royalty anyway.) The orientees were impressed. I was impressed with the way the sore I used it on is looking already, after two days of use. I never cease to be amazed at the way some things heal. And I can't understand when some of my coworkers say, "Well, we could just use a wet to dry dressing!" Not on everything you can't. It's just not the same.

I also got to dress and redress a couple other wounds due to various bowel and bladder accidents. Some people will never learn, nor listen to their nurses...arrgh!

More to come...

Thriller CoS is on the rise

Check out the latest Change of Shift over at Reality Rounds if you dare...and no, Michael Jackson won't be there...BWAHAHAHA!

Nuggets for October 21

Yes, it's that time again, folks, so here's a roundup of the latest and greatest goodies I've found in between reading for grad school (aka the secret escape plan at your very own desk) and stuff from my daily life on the floor.

Medical goodies

In nursing school, you learn about all the different lab values. Some, like the various cardiac enzymes, are taken a little more seriously than others. Some values can be off. This article at www.medscape.com called False Positive Cardiac Troponin Results described my day recently.

Another interesting article, also on Medscape, discussed the Cutaneous Complications of IV Drug Use, which has been more apparent in some of our patient population recently. Note: there are photos with this one, and some are very graphic.

Reuters recently had an interesting article about stress: Stressful childhood may mean earlier death. And probably the best article, One pair of dirty hands equals many infections, describes what happens if one person doesn't wash their hands.

The Sneeze Sleuths are featured in a Wall Street Journal article about allergies.


Etc.

Want your husband to do more housework? Check out this article called the Sex-Housework Link from the folks at the Wall Street Journal of all places.

Wanna find out what telemarketing company is calling you? Check out whocallsme.com for more information on some of the phone numbers telemarketers like to use.

Sliver of moon...

That's what I saw when I looked outside tonight. The new moon is nearly upon us.

Work is still the same old, same old, which will get more fun and exciting when the annual vacation schedule for next year is turned in soon. Lots of wailing and gnashing of teeth. Boss enjoys the position of keeping people in suspense, so we're still waiting to see who he's going to assign to work Thanksgiving, since everyone knows the nurse with the most seniority, S, is already off anyway, just like every other holiday (and day after, if she chooses).

It's always fun asking the specialists questions they don't expect...like why were using a product off-label. Thankfully, the guy I asked has a sense of humor. His boss, the chief, vacillates on humor on, humor off some days, so he doesn't always like to be asked. I did get an interesting answer, so I was happy I asked. Met one of the specialist's new residents who is really good. Now if they could keep her from writing goofy all acronym orders, that would be even nicer. No wonder JCAHO has a fit at our place all the time!

The Slug did an unusual thing today...missed a personal phone call during business hours. Yes, indeed, another sign the moon is changing!

I've had fun so far this week. I got to play with some new tools and get them to work after only a couple of uses. I'm one of the few people who use this product right now, but it's so much better than the old stuff. I can't wait until Santa brings us a couple more!

School is still school. I attended an optional conference via web today, so that was interesting, especially since my instructor was there, too. (She must attend all of them). Hopefully, my redone paper got a good grade.

On top of that, I've got my date for the my certification exam...just days after the semester is over. At least, I'll have a little time to celebrate.

More later...still tired from yesterday. Stay tuned.

Take a break...

Bubba and Dahey are doing the fun stuff and I'm theorizing here and searching for stuff for the next paper.

Arrrgh! So glad I'll get a break tomorrow at work!

And now for something completely different...the Nobel Prizes have already been awarded and so have the igNobel Prizes, but you've gotta love this igNobel one for the bra that will save your life.

Maybe if we run out of N95s at Madison, I could use one of these!

You gotta go...

See this post at the Jage Page. Well said!

That is all...back to homework. More to come...stay tuned!

Neither rain...

Nor sleet, nor snow, or conference in Vegas will stop Kim from posting the latest version of Change of Shift.

Head on over and check it out!

Butter me up

I just couldn't resist passing this goodie along that I found at Serenity Now Hospital.

Gotta love a little gallows humor. Thanks Doc!

Crazy...?

I hope not...but who knows for sure.

Weather is frightfully cold this year. At the rate it's going, Bubba will have to go out on Halloween as a skier in a snowsuit.

Crazy patients were calmer lately. Could have something to do with actually scheduling anti-psychotics instead of making them PRN! I can leave the room being nice and still be nice to that same patient who thought I was back to kill him when I left for five minutes to go to the vending machine for his Coke.

I had free time to work on homework on my break.

May miracles never cease!

Nuggets for October 8

Goodies too good to pass up...some I see every day and some I just see and pass along to you! Enjoy!

Cool toy

Since some of my grad work is on tools to do a better job in healthcare, we'll have lots of talk in class tonight about Microsoft's H1N1 assessment tool, created with a little help from their friends at the Emory School of Medicine.

Other toys in the medical world

We're always fixing up lots and lots of people with sores of all sorts. Wound clinics can have lots and lots of sores--diabetic sores, pressure sores, and good old generic trauma.

How do you fix them up?

Sometimes we use radio therapy devices. Or we may use a combination of things, such as WoundVACs and hydrotherapy, as noted on this page. If we can get access, we might use hyperbaric treatments, but due to cost, this is rare.

And if all of this stuff doesn't work, there are folks working on a mathematical model for wound healing.

Freebies?

Oh, if only I could have a problem like this one mentioned in this article in the NY Times about bloggers and product reviews....

Hmm....and what would a rehab nurse be likely to receive or review?

I'd have to borrow some patients, because I surely would not review any bowel preparations. We have a character who comes to our place and preaches the miracles of this particular preparation.

I'm still a coffee girl (someone's got a mug that says "Coffee it gets you going"), so if Starbucks or some other really good coffee people come my way forcing samples on me (like they did the other night with that VIA when I was getting my latte), I'll gladly share some with my evening and night shift friends. (I stash my coffee in secret places at work). Shoes would be another weakness. Doesn't matter if it's high, low or in-between heel, sandals or boots. Work shoes would be welcome, but I'd have to practice wearing them at home first. No way do I wear shoes directly to work without hanging out in them a while to see what happens.

Now, if I could get a few samples of perfumes or chocolate truffles (or just about anything chocolate for that matter), I'd be in heaven.

And, of course, I'd share all my details with all of you.

More to come...back to papers and theory and paying bills...

Monday drifting

Its never easy
And its never clear
Whos to navigate
And whos to steer
So you flounder drifting ever near the rocks.

--Dan Fogelberg, Hard to Say, 1982

I knew something weird was going on when I awakened early in the morning after a lovely dinner at home with my family. I even got my paper all fluffed, buffed and edited and sent to my instructor. Dahey and Bubba had a nice day. It was one of those dreams that wakes you up and you can't go back to sleep. That was me, only I awoke to the smell of something cooking. I investigated and no one was cooking at my house.

Finally, cups of coffee later, I got Bubba out and rolling. Once I got in, the slowness of the hallway surprised me. Even at breakfast time, there's a rush at our place. Nurses feeding people, setting people up, giving meds. Today it was hushed. I found out why when I saw the code sheet at the desk. The procedure details told me something was up. I ran to one room and saw that patient was watching TV, with breakfast over. Once I saw him, I knew exactly who it was. I just didn't know the story.

Report comes in. It was my patient who I took care the last few weeks. The restlessness and dreams and the odd things said all came back to me. I felt like I was reading that book again. I was disturbed, so when I saw the chaplain come around, I talked to him. That helped.

Mondays at our place are usually nuts, so I went on and got my patient ready. Even with all the hubbub, it wasn't as bad as I thought it could have been. We talked amongst ourselves and laughed about this patient. He/she was just a character, and it was very evident in the last few days, as he/she got up and out of the room. Some days I just walked out of the room and chuckled to myself, "What a character!" And it wasn't just me, either, since he/she regaled the docs just as much as the nurses and staff.

Finally, I went home, and on the way, in the fall breeze, I just thought about how lucky I am...and how free one character is today.

Hope you two are enjoying that burger...wherever you are!

Not a hospital-sanctioned sport

Some people watch ESPN and pay attention to the sports.

Some people watch ESPN and pay attention to the commercials.

And some people who pay attention to the commercials and are pushing 100, ask their nurse how they can score some Levitra (which just happens to be on the commercial). Paging Dr. S.! Yes, indeed, Dr. S. is the man for any ED drugs at our place, after, of course, you get the "education" required.

I guess this means Mr. X is feeling better now, so it should be an interesting weekend!

Come on down!

Is it your turn on the Price is Right? It's is for me...thanks Bob! I mean Kim for inclusion in the latest edition!

If not, check out this latest edition of Change of Shift over at emergiblog.

http://www.emergiblog.com/2009/09/change-of-shift-vol-4-number-7.html

Happy Anniversary

Oh, a few years ago, I was fretting away getting my hair and nails done right about now, just before the wedding.

A few lost in-laws and nine wild years later, here we are...and we're celebrating with the modern anniversary gifts this year! Woo hoo!

Happy Anniversary Dahey!

Up, down and all around

That's been my story lately. A lot of things almost whirling around my head and inside the building. A fly kept buzzing the table as K. and I ate our dinner. I watched it whirl around the room. No matter what I did, it wouldn't land.

Later that evening, K. caught said fly in a weak moment and slapped it dead on the table, and sent a bag of open potato chips all over the floor. Thankfully, one of the nursing assistants found the broom and dustpan (housekeeping usually locks this stuff up) and it was cleaned up quickly.

My patients were reasonably good. Both have my least favorite bug, C-diff. If I only had a dollar for every time I was in their rooms and for every, single, solitary time I had to wash my hands (since that ol' hand sanitizer won't do with C-diff), I would have a whole lot of money. I am so paranoid with C-diff. I go home and disinfect my shoes with bleach spray (since housekeeping hides ours).

School's gonna kick my butt if I'm not careful. My first paper came back yesterday. I talked to the instructor about it because of the grade and we have a resolution. Stay tuned! I have two weeks to resubmit, which I thought was a nice thing for her to do. From her discussion, I suspect she gets a lot of people who would be going to the dean or something if they don't get x grade. Not that I like a not-so-hot grade, but if the instructor's amenable and has a solution, I have no problem working with them. We'll see how it goes. I have a few more ideas and another paper to submit by Monday. This weekend will be busy in a few more ways than one.

Gotta run...an off day means errands and homework! More to come...

Some things change...

And some stay the same.

The unit was pretty much same old, same old last night. Nothing particularly new and exciting.

1. The Slug is still the Slug and wouldn't know his/her backside from a hole in the ground (Dad's favorite saying...only a little spiced up!). He/she obviously didn't look out the window before swearing, "Oh, all these patients are crazy because it's a full moon." Not really, but perhaps on whatever planet he/she's on, it is!

2. Ringing the call light at the change of shift is becoming commonplace whenever I work evenings. One patient decided he needed help in less than the five minutes it would take the ongoing shift to get him situated. So what does he do? He says, "I think I'm having a heart attack. My left arm feels funny." Roommate was oblivious to all the commotion and snoring away.

Here goes the fire drill. Get vitals, get him repositioned, get out the EKG machine and call the doc on call. Nice. Thankfully, the evening charge nurse and I went down with some of the night shifters and got him all situated until the doc arrived. No other classic signs and a "I thought I'd say that so someone would come down here right away." almost merited the famous Dope Slap from the night charge nurse.

3. And finally, some people are still on evening bowel routines on our unit. Some are scarier than others. One of my patients had one which reminded me of a horror movie about tapeworms.

That is all...stay tuned for more excitement.

They tell it like it is...

I really enjoy reading articles about centenarians. Unfortunately, many times there are lots of obits, but I really enjoyed this one from the current world's oldest man in Montana. His advice: don't eat so much.

One of my other recent favorites was the obit for Gertrude Baines, who died earlier this month. Her long-life secret: crispy bacon. As another crispy bacon devotee, I have to agree with her. One of my grannies lived to be 93 and she swore by a nip of schnapps every night. It was the only "medicine" she would ever take.

I don't think I'll be taking up schnapps any time soon, though.

More to come...stay tuned.

Vacate for a vacation

Yes, it's true, I've been enjoying mine for the past week and I have to go back to work tomorrow. However, I can't imagine not having any time to recharge and renew. One or two days in a row is just not enough.

I read an article recently that stated, "According to an Expedia.com survey, 35 percent of Americans don't use all of their vacation days each year." Sure, some places may pay you for saving up your vacation days and cashing them in, and in this day and age, it wouldn't be too bad, but I cannot imagine doing that anymore. I just need my sanity. Sanity involves leaving the premises and not coming back for a few days.

The best thing I read about vacations was this list: Signs that you need a vacation. Reminds me of the Dilbert book I read at the store the other day: What do you call a sociopath in a cubicle?

Another article talked about how vacations can help you with job performance. I totally believe this. While I'm expecting to get the most demanding assignment on the floor when I get back (they like to do that to people returning from any time off on my unit) right now, I feel as if a rest will be helpful in dealing with it. Having memories of quiet time, coffee, good books and bubble baths, even now, makes me feel relaxed. If that doesn't work, a good time-out never hurt anyone!

Nuggets for September 24

Yes, it's been awhile, but since I've been on vacation, I figured I should just stop the early Christmas shopping and get with posting a few of these goodies. Hope you all enjoy!

Pandemics-R-Us

Since it was on my list of things to do, I got my seasonal flu shot this week.

It's easy to get caught up in the hype, but keep your wits and learn something from the CDC's page on H1N1 flu.

On the subject of flu, my personal favorite in the "when people get carried away" section appeared recently in the NY Times with some great photos and is called City Critic- What not to wear when worrying about the flu. No, Tyveks are not fashionable this year. Big thing to remember: hand hygiene people!

Family fun

The myriad of articles on family dynamics, etc., really surprised me. Here are some I found interesting:

Seven ways your siblings may have shaped you (from Yahoo!Health)

Mama wasn't always right: 9 updated health rules (from cnn.com) Guess I won't get in trouble for reading in low light anymore!

Medical news of note

I am always fascinated by brain stories (I guess in another life I was somewhere in neuro) and this one was really interesting: Brain pacemaker for a rare disorder (from msnbc.com)

The BBC has been having some very interesting articles on health, and here are a couple below.
Antibiotic resistance clue found

And because most of my patients are in the target demographic for this...
'Viagra cream' could prove safer

Tools you can use
And finally, since I've been embarking on a few home improvement projects, check out these nifty health related tools. No batteries required!

The ANA has a new site on Safe Patient Handling. It's got a lot of information you don't want to miss to keep your work environment safe.

I found this one thanks to a nursing newsletter from the ANA. Statistician George Fernandez at the University of Nevada at Reno has devised an even simpler implementation of BMI called MWL or Maximum Weight Limit. The calculation is a breeze, especially if you don't have a calculator handy.

Happy Rehab Week!

Yes, indeed, it's time to give a shout out to all my fellow rehab nurses and all of our friends in other rehab-related specialties, especially the therapy folks.

Want more info? Check out The National Rehabilitation Awareness Foundation for more information.

Lift, load, upload and loaf

Happy Monday from the land of ahhs! Ah! I turned in that paper I was working on this weekend, in between loading up my iTunes on this laptop. I just never got around to it a month ago because school started and I had other technical issues to resolve.

Now I've got a lot of very wonderful stuff from ABBA to Van Halen to Vladimir Horowitz. Dahey has a huge collection of all sorts of stuff, so I'm just loading up, including the Christmas music (can't find any Hannukah or other holiday stuff anywhere right now.)

The loading happened earlier today when I went in the storage area and started taking out all the stuff I triaged and set aside to give to charity. Loaded up the battle wagon twice and got a good chunk done today. Put some big items up for sale, so we'll see how that goes.

The loafing...a nice, uninterrupted bath and a book. It didn't last too long, but it was nice.

More to come...stay tuned!

Decompress

Ah, it's so nice to be done for the weekend...and able to look forward to a week in which I don't have to go to work.

There have been a few surprises. The trainwreck elderly patient I ended up with on my assignment really wasn't bad at all. For a man of few words (can't speak due to a trach issue), he's pretty funny. Lots of flailing gestures and an animated face make it pretty interesting.

My other patient was grounded, too, due to some other health issues, but surprisingly, I found stuff to keep him busy and he was relaxed and happy. I was worried he was going to get wigged out about staying in bed.

Most of the people I work with were pretty good, too. We have a lot of new people floating around the unit, so maybe people were just on their best behavior. The Slug, of course, was not. He/she literally tied up every phone at the nurses' station (with personal calls) and even the boss thought it was funny. It just goes to show you what leadership (or lack thereof) we have. Someone else will have to fight that fight...I just don't care. Put me as far away from that phone as possible, so I don't have to answer it!

We got some new toys on the unit--lifts, stretchers and a new computer. I didn't have anyone to heave around or take anywhere, so I played with the computer. I like working with new stuff, even if some of my collegues recoil around anything new. I'd rather just play with it when things are slow and figure out how it works. We had another department come around with new snappy accessories for the computers, so we had fun with those.

While they won't be doing what they do in Europe, we will be getting tested for MRSA in the nares one of these days. One of my coworkers asked to have her MRSA scheduled for when her kids are out of school if she would have to stay home. Me, too! It would be the only way I'll ever get the summer off without having to go back to school to become a teacher.

Speaking of school, it will keep me busy this weekend. I have to work on several projects and write a paper for my class. When I get done with that, I'll be tackling the house the rest of the week. It should be fun.

More to come...stay tuned!

It's an emergency!

Medic999 is hosting this latest edition of Change of Shift, so head on over stat!

BTW if you want to know what a Geordie is, head on over here.

Fluids, flotsam and jetsam, oh my!

That was the story of one of our shifts.

Need D5 1/2NS, which is one of the more popular fluids on our unit? Gotta run around to find it. Those supply people must have had a bad day because no one at Madison had more than one lonely bag.

I deal with lots of fluids and stuff--urine, sputum, feces, but every nurse has a weakness for one. Mine is vomit. I'm not phobic, mind you, I just don't like being there for it, or dumping it, but I had to do that the other night when one of our people got sick, right before shift change. Patient got his PRN Compazine but was still retching away an hour later. I got to pass him on to the next shift for a fluid order. Too bad he didn't have his PICC anymore...he's a terrible stick.

More to come...stay tuned.

We let go

"When I was a child, I used to speak like a child, think like a child, reason like a child; when I became a man, I did away with childish things." New American Standard Bible (NASB)

We let go of a few things on the last shift. One of our regulars, who was injured years ago and a world away, coded suddenly as we got report. He had been sent to Washington to be monitored, but was going downhill since he left us.

We liked him. He kind of grew on you. He was quiet and unassuming and loved his baseball games. We never worried about not knowing what was going on with any televised baseball because he'd keep us apprised whenever we asked. I always went by his room to ask the score, and while I was there, unwrap his snack and open his milk.

He was someone who was always grateful. Grateful he could still use his arms. Grateful his family was still around. Grateful for friends, who would bring their children to visit him.

As a wounded veteran, he was a brother in arms to the younger guys who were injured. He'd light up when people asked him to help out by talking to a newly injured patient. He was a great listener and was a pro at making people feel at ease.

Though he was modest and generous, we often laughed and called him "the colostomy salesman". He said it was the best thing he ever did after his injury, because it helped him to live independently for so long. He had one so many years, he could tell stories about how it used to be, and how he liked it now.

Overall, we were sad to hear of his passing, but we delight in the fact that he will not suffer anymore. Happily, we let him go, hopefully, to a place where he is free of all pain and suffering, complete with his own field of dreams.

Sore

Flipping people around in beds and chairs can be exhausting as a rehab nurse. You expect muscle strain from that.

You do not expect, however, people to leave large objects in front of walls near swinging doors, so when you open them and push you push into said object and into the wall.

And crunch yourself into the door, and feel the pain of the combo lock hitting you squarely in the chest. Nothing like a little pectoral crunch at night. Now I have some idea of how people feel breaking their ribs.

Guess I just have to move slower! Stay tuned...

Never forget...

That on this day, and at this hour, eight years ago, New York was burning, the Pentagon walls were breached, and multiple heroes on a plane gave their lives in a Pennsylvania field to stop further carnage.

And our little, insulated lives as we knew them changed forever.

Nuggets for September 9, 2009

Yes, it's 09/09/09, and according to some, a lucky day. In light of everything going on the past few weeks and months, I consider every day a lucky day and some better than others.

This week's installment of Nuggets includes the best of my fellow bloggers out there in the blogosphere recently. Please check these stories out and enjoy.

Head Nurse always has some interesting stories. I'm a story person. If you like good nursing stories, you have to read Holes, part two. My favorite line is below, and it sums up how stories can really make your life.

Those who are not here any more eventually, and irreversibly, define what I am.

Keith at Digital Doorway is heading out on the open road and feeling stirrings of nursely guilt. Godspeed, Keith. Enjoy your travels wherever you may roam!

Maha has a great post about alternative medicine and diabetes, which, thankfully, did not have disastrous results.

And while this is not a healthcare blog, I found it via another nursing blog. If you like food and you like funny stuff, check out Cake Wrecks, which is subtitled when professional cakes go horribly, hilariously wrong. It is hysterical!

Shout and Out!

Yes, it's time for a shout out section again thanks to sitemeter, so here goes...

The international section

Yes, to all those folks in France, especially in Paris and aux alentours who keep meandering by...j'arrive...je suis un peu fatiguee a l'instant! Le cours d'info m'echappe!

Hello to all the other folks coming by from India and the Philippines. I have to mention the people getting here from Under the Mosquito Net out of beautiful Bangladesh. Thanks Randall for the link by which they got here!

In the western hemisphere

I'd be remiss if I didn't thank maha from Call Bells Make Me Nervous. So many people lately come by way of your blog. Many, many, many thanks, and if I'm ever in your neck of the woods, I'll have to stop and say hi. Kim at emergiblog also sends lots of people here, so I am very, very grateful. (I'll be jumping up and down when I have 10% of Kim's traffic!)

And all the readers from Kansas City, MO; Atlanta, GA; and all sorts of good folks around Houston, TX, especially at the Health Sciences Center, thanks for coming by.

So now more stuff...

Lately, I almost feel like doing a gutteral scream and yelling, "Out!" Out to the dog who goes from sleeping to sick...all over carpets and flooring. Out to kid who says, "Mom, can we change the channel to the Kid channel?" about 40 times at once. Out to all the stuff I have stuffed around the house that I really need to get rid of, once and for all. Out to all of the computer demons who have been inhabiting two of my oldest computers. Not viruses, mind you, just plain old out-of-resources, maxed-out memory craziness.

Recently, I really wanted to tell a patient, "Out!" Said patient is getting ready to discharge yet again after the latest of said patient's plastic surgeries. Multiple issues I really can't discuss abound, but as usual, patient likes to have fun with the nurses by causing psychosocial issues. One minute, patient makes you look great in front of providers. Next minute, patient is telling you how his/her legs were moved incorrectly during transfer and that popped the colostomy bag.

To save time and patient satisfaction scores, I excused myself and took a time out. I got some labs that were needed and said patient talked on the phone. By the time I got back, I was accused of not listening, but I got patient out of bed and out of the room. Thankfully, patient took self off the unit outside, which got rid of some of my angst.

I have a plan, folks. It shall be implemented fully any day now. It's called vacation. I'm not going anywhere, but I will be doing something. Homework in multiple senses of the word. I've got my assignments, now I just have to produce the papers.

Finally, since it's 09/09/09, I'll just twist and shout over to the record store. Today is remastered Beatles release day.

More to come...

Happy Labor Day weekend

As one of the few, the proud, the folks who are off this Labor Day weekend, I celebrate by doing my homework for class and all sort of other stuff I wouldn't normally do while working.

I found this Labor Day quote below by H.L. Mencken here:

The only liberty an inferior man really cherishes is the liberty to quit work, stretch out in the sun, and scratch himself. ~H.L. Mencken

Enjoy your weekend wherever you are, whatever you choose to do!

United front

These two little words can mean a lot of things, and they're coming in to play at work.

Case in point: veterans want one display in the building. Big cheese says no way and removes military display. Many, many people pissed off on this laundry list: veterans who are our customers, veterans who are our employees, spouses of veterans and spouses of employees who are veterans and visitors who hear the story. Air Force veterans, Navy veterans, Marine veterans, and most of all, since there are so many...the Army veterans.

A whole lot of wailing and nashing of teeth. Can we get the boss to believe he/she is wrong?

Stay tuned...this may take an Act of Congress.

Yes, it's crazy...

But don't miss the latest edition of Change of Shift up at Crazy Miracle Called Life.

Psychosocial Insecurity

Our little unit is an open-door haven that former patients visit regularly. Even when they're visiting other folks in our building, they tend to wander by the unit, to see the staff and to see if they know anyone who's staying with us. It may seem unusual to some, but not to us.

Then again, some of the people who stay with us a long time (and they probably make up at least half of the unit) don't want to leave. They enjoy the security of knowing they'll have help whenever they need it, or twenty-four seven room service we like to call it.

Right now, we have a couple of folks ready to leave us and they are suddenly getting jitters. "Oh, I feel sick." "Oh, I can't do this (or that.)" "I don't have any help lined up yet." Surprise, surprise. If we got out our Carpenitos for nursing diagnoses, we'd surely have a lot of these psychosocial diagnoses: Ineffective coping, relocation stress syndrome and my personal favorite, ineffective denial.

Despite the best intentions of getting sick at the last moment to postpone discharge, our first discharge guy left. He not only left, he waited all day to do it. He couldn't rush, because his help wouldn't be there right away. As when many people leave, some people count down to the next time we'll have someone back...as a long-term customer again. Those maudlin thoughts just creep up, even if office pools are forbidden.

One guy keeps leaving and coming back, because we keep discharging him for medical issues too acute to be handled on a rehab floor. I wonder how long it will take before he doesn't bounce back again. Age and infirmity can do that to a person. While I was off this weekend, he was back for one day and returned to acute. He didn't even make it 24 hours on our unit. I guess our idea of stable is a little different than the acute hospital's idea of stable. Not breathing and cyanosis just are not good things.

If the internal excitement is not enough, we have prowlers looking for privacy violators. Yes, it's all because of the good ol' JC. They're on the loose so this is practice...just like those quarterly fire drills. The boss just about had a fit when I gave a chart to a doctor. I had to prove I saw his badge and look him up in the computer. Good thing he's a psychiatrist with a sense of humor!

All this and H1N1, too. It's going to be a rocking end of this year. I'm just crossing my fingers!

More to come...

Bubbling...

Not frothing, mind you, bubbling, like a nice pudding cooking on the stove.

There's a post in my mind that I just can't get out. I'm hoping my writer's block is not contagious, nor long-lasting. Grad school started for me yesterday and the assignment list is pretty long.

Off to clean and cook on today's day off...more to come, so come on back a little later.

Bed-lam

Yes, I'm being silly after my most recent evening shift because I can. I feel fortunate that I left with my mind reasonably intact to drive home.

It's not even a full moon, but the crazies are out. We must be running a special, and while we're not a polytrauma unit, we keep getting TBI patients, who just came off one-to-one status. We don't have enough regular staff, nor PRN agency staffing, like the mothership, but they can send us people and suddenly, they don't need that one-on-one anymore. Hmm, must be a lot of miracles going on these days at Madison. The only miracle I see is the patient leaving one place for another (our little unit).

The crazies aren't actually the TBI people. Happily, they've been quiet. The crazies are our regular, crochety characters who really need to go home. They're bored, so they create problems to get attention diverted to them from other patients.

One regular decided his bed was too hard. (Remind you of someone...maybe Goldilocks?) We called the bed vendor. They check out fancy low air loss mattress on the bed. Bed works based on all their requirements. Patient waits until bed vendor is gone. Patient goes crazy, rings lights, spews expletives and acts all sorts of silly, just below the level where we can call security and get him some nice Haldol (a spray can of that would have been a delight). Charge nurse had to get one of our regular beds and plop Crochety on it, so he'd finally be quiet, for a moment. He continued to be a regal pain all night, for one reason or another. Sometimes, I think this patient did this because he was genuinely bored and it is truly a control issue.

My patients were reasonably good, but I always wonder why the boss gives me the assignment I get. It never ceases to amaze me that I get an assignment to give out pills to half the unit and try to feed two people at once.

Besides Mr. Crochety, we had a guy get unstable on us, so he took an ambulance trip. He was diverted from the hospital we intended to send him to, so the charge had fun getting with the ambulance crew to find out where indeed he was, since she had no idea to whom to give report. Turns out this patient verbalized chest pain and they pulled off and got him to the closest hospital en route instead of trying to get him to Madison.

I ended the night by finally doing all of my charting. I usually chart as I go, but there was no way to do that on that shift. Finishing with my faculties intact was enough relief for me.

Stay tuned...who knows what wild and crazy stuff the weekend will bring!

When life hands you lemons....

This lady has made lemonade (see this photo). There have been a lot of stories in the news lately about service animals and schools (for more, see this CDC page), but this was the best one I've seen yet. Occasionally, we see a patient or two with a service dog on our unit.

Hope she has a big office with a nice park or something outside where she can walk with her friend at lunch.

Nuggets for August 26

So many goodies, so little time. Here are a few interesting things I've run across in my travels on the internet. Hope you enjoy!

The Bellingham Herald has an interesting piece called Why Medicaid should get out of the long term care business.

The Wall Street Journal online had an interesting article recently called Hospitals Own Up to Medical Errors.

The NY Times has had a few good stories recently you should read if you haven't already:

For Parents on NICU, the Trauma May Last
PTSD is not uncommon among the parents of preemies.

Saving the world's women
This article, from the NY Times magazine, details the plight of women in the developing world.

Guilt and Atonement on the Path to Adulthood
An interesting view on children, self-control and guilt

He was, and still is a hero...

To many people on our rehab unit, Christopher Reeve is gone, but not forgotten. He brought spinal cord injury and related research a spotlight with star power. Who could ever believe Superman could become a SCI patient?

His son, Matthew, is running marathons in his honor on Team Reeve. Check out this story in the NY Times for more information.

Throttle and hum

My day was humming along. I got my people cleaned up and all ready for the day. Then it was time for the tasks.

We had to move one patient around because, per our isolation status, his room had to be cleaned and he had to get a new bed. What fun....move patient to new bed, move him to a different spot, get the room cleaned, then put him back. All this so he can get his GoLytely for a colonoscopy. He was not thrilled once he tasted it. "Yuck. No way I can drink two gallons of THAT!"

My other patient was relatively easy. Get him a new Foley and rotate him around. No fuss, no muss. He stayed up really late watching TV so he slept most of the morning.

Then the throttle...the call to go home to get that necessary utility fixed, since they keep messing with it outside. Fun. Husband can't leave work, so I get to leave. I'm so glad the commute is short. I made it there just in time to let the repairman in the house.

More to come...

Sure, it looks easy

But running around and doing everything you need to do on Monday can get really, really crazy.

I thought I had a reasonable assignment, but I ended up getting involved in miscellany again. One minute it was transferring a patient who didn't want to go anywhere for a test, the next it was changing trach ties. Finally, I get my people finished in time for lunch...literally just in time, as lunch was delivered.

Next, I straightened a room, ate my lunch and enjoyed peace and quiet, when I found out my admission had arrived. I spent the rest of the afternoon getting things done--assessment and paperwork. When I thought I was done, I had to teach to a few people how to draw blood from a PICC. Oh, we so need a refresher on blood draws for some people, including order of the draw. I also realized I need to get educated on bloodstream infections, particularly regarding blood cultures and PICC catheter cultures.

Finally, I finished my day. I was able to sit down to do my paperwork. While I had a moment, I got in on a conversation about alcoholism (an observation by another coworker) and she mentioned this resource. It also made me think later that we might just need to involve more of our patients in alcohol treatment programs than we currently do.

The day didn't quite work the way I thought it would, but it was not terrible. We'll see how the rest of the week goes...stay tuned.

Get it. Got it. Good.

Kim's got Change of Shift up at emergiblog right now. Don't miss it!

Remember that patience thing?

Thank goodness I had a lot of patient patients today. Oh. My. Freaking. Heavens. If it wasn't one thing, it was another.

I never do EKGs and I had to do two today. I am so, so, so happy one of our new (to us) nurses was working, because, with her help, F. and I tag-teamed to get them done right after another when the docs would go from "Hi how you doing?" rounding, to barking this order and that STAT! F., I wouldn't have made it without you!

Other people who are getting ready to go home decided to get sick...or get a PE or something. Just what I want to do near the end of the shift.

And my regularly scheduled people? They went with the flow...no whining or no crabbiness.
Even though my back hurts, I ended up having a good day.

More to come...stay tuned.

Please be patient...

God's not done with me yet." -- sign on a door I saw recently.

With the influx of people recently to our unit, I'm reminded that my services are important where I work. Sometimes I get frustrated because I see people working as if we're in an assembly line. Do the tasks, run to break, go back and then clock out. I have to work daily to remember a few very important things.

First, I'm dealing with people, not auto parts on an assembly line. Deviations can, and will occur on a regular basis, because of the all the people involved in the process.

Second, I may have that task list in my mind, but I'd like to do things better and try new things. Many times patients can clue you in to tricks you never may have thought of employing. One patient told me recently, "Hey, I can't move that arm, but if you put it on a pillow, I can wiggle my shoulder some if I need to and that helps me." Hey, I'm no rocket scientist, but if it makes you happy and keeps you from hurting, let's do it!

Third, patients can and will speak if you let them. Sometimes the best thing to do is shut up and listen. Here are a few of them speaking on the internet. I hope you take the time to listen to them. I did and thoroughly enjoyed these stories and sites.

I found Astrid in the Netherlands from my sitemeter log. I was equally impressed that I made her blogroll. She's got a great blog with loads of posts about dealing with blindness and her other diagnoses. Don't miss it!

Patient Dave talks about you owning cancer or cancer owning you amid other interesting posts.

Steve's got lots of information on Adventures of a Funky Heart, as an adult congenital heart defect survivor.

Leslie has a great blog called Getting Closer to Myself. I really enjoyed this recent post called Everyone wants to be a 10, but no one wants to be a 710. You'll have to read it if you want to know what a 710 is!

Not what you'd expect

It was education night again recently. I am always amazed that new patients and new nurses can really get the conversations flowing.

A new patient came to the unit recently. He won't be with us long, but for the new nurses, he'll be remembered. He was slight with salt and pepper hair. He had just arrived and since one of the newer nurses gave report again, we had little to go on, so I headed to the chart. Not much there, either, but I managed to piece together a little story.

Patient is living his life with family in a successful blue collar job and has a "nervous breakdown" and never returns to his job. A few years ago, he gets diagnosed with MS. He goes from walking around house to pushing himself in a wheelchair.

The most striking thing among the new nurses is that they're hot for a diagnosis. "Wow, look at him shake doing xx," one exclaimed. "Are we taking Parkinson's patients now?" No, I reply to NN1 (New Nurse 1 --we have several right now), remember Mr. X has MS."And so education begins...

Where do we start? We comb the chart again, and finally, the docs update the notes. We know he has MS and from the chart and meds, we can tell a few things about him. He's got those tremors because he's had lots of issues going on upstairs, because of the infamous plaques. He's had lots of seizures, and tried lots and lots of meds, most of which give him reactions, so he's been switched around a lot. Next, we see he's on some different treatments, too, which are often used in areas outside MS, particularly in transplant patients. Following that, we reviewed some neuroanatomy. The brain is a wonderful thing. It's got several mechanisms to tell you that something's wrong and generally gives you an idea of where the problems might be.

After we looked at his chart for more information, we headed on over to the MS Society website for more information. This had the new kids going for at least an hour, but I suspect a few of them will keep learning, eager to absorb whatever they can. The Professionals section at the MS Society has an area specifically for nurses. More good sites for information are the following:

The MS section of NINDS the National Institute of Neurological Disorders and Stroke (from the NIH)
IOMSN International Organization of Multiple Sclerosis Nurses
MultipleSclerosisProfessional.org
Neuroanatomy online has lots of MRIs and other graphic information on neurological disorders.

Sometimes an unexpected event leads to lots of learning. We'll see where it goes.

More to come...stay tuned.

A little light cynicism

Oh, it's the latest initiative...put everyone in a room, have them bring their lunches and talk. Yes, they've brought back the famous "lunch and learn" but not on any topics you want to learn about. (I'm just hoping most people aren't bringing this lunch along, or it will probably negate whatever they learn.)

No, our topic is, in a nutshell, "how do we get along and play well with others without acting like primadonnas." Guess we gotta start somewhere.

Thankfully, none of these are mandatory...and many are planned on my regularly scheduled day off. I'll be thinking about the stress relievers as I relieve my stress at home cleaning or at the salon getting my regularly scheduled services.

As they say, charity does really begin at home.

Nuggets for August 13

There were a whole lot of interesting items out there recently, so here are a few of them for your viewing pleasure.

You've got questions...

They've got answers, and no, it's not an electronics store. ConsultantLive had this great article on the ubiquitous purple urine bag. I've seen it a few times before (also blue) and asked questions about it, and never got a straight answer until I found this article. They also have a number of other articles of interest, so peruse at whim.

Crispy and brown

Feeling burnt out? Need to read something to get you going? Laura Wisniewski has this great article over at www.nursinglink.com called Re-Engage Your Passion for Nursing that has a few interesting points to ponder.

A telling anniversary

It's been ten years (yes, it was 1999) that the IOM published To Err Is Human: Building a Safer Health System.

There are still lots and lots of mistakes happening out there. The Houston Chronicle (a Hearst Newspaper) recently ran a series called Dead by Mistake on what the state of error reporting is in the US, and it's not so hot. Don't miss it.

Study, study, study

I'm still doing some certification study (yes, it seems like forever...) and I ran into some terms I didn't recognize, so I went searching and found some articles of interest.

Glossopharyngeal breathing is used with some ventilated SCI patients. This article explains what exactly it is and how it works.

Figure ground deficit is explained in this Google Book called Neurological Disabilities: Assessment and Treatment.

I always feel weak in my studies of the brain, so I found this article about a particular TBI patient very interesting as an aside. (from http://www.nytimes.com/)

Privacy (or lack thereof)

And you thought a prescription was private (from http://www.nytimes.com/)
I just shuddered reading this article...what will they think of next? I'm sure all you pharmacists out there have some stories like this.

And everything else about bloggers

It seems like life is very electronic these days...with good and bad results. Here are a few articles about various topics related to blogging I've seen lately. And, no, some things just don't need to be blogged or explained electronically, at least not in my little world, thankyouverymuch!

Mommy bloggers and ethical conflicts (from http://www.cnn.com/)

A no tweet, no blog party (from http://www.nytimes.com/)

Wild and wonderful

That's been my story at work lately. The transition from one shift to another sometimes can be wild.

One day, I walk in, get going and the gates of Hades open all at once. Nurse Assistant has a patient who's got shortness of breath and "looks funny". Well, he's not acting funny, but probably is a little shaky from the albuterol he just took. Get him situated, tell docs, do vitals, get more albuterol. In a few minutes, patient looks happy as a clam and is chatting away as the nurse assistant gets him ready.

Another day, the specialists round. They like me. Not only do I get to deal with my patients, I have to help them with paperwork on a couple of others, because I know how to work the computers for that feature, even though, all I do is act as a witness. Gee, I feel so special! Thankfully, boss and company only follow these people around once a week. Other nurses thank their lucky stars that they don't get "picked". I've known the specialist for a while before I came to Madison. He can be loud and obnoxious, but underneath, he's a softie. He just doesn't want any of the nurses to know that.

Doc Specialist is also a running doc. It seems like the specialists drift to one of two categories--they either golf or they run. Our leader is the exception. He's too brainy to do either; although, if I had to guess, he'd probably fall in a lot easier with the runners rather than the golfers.

So after all the wild and crazy antics, I get a phone call. Miraculously, I got a scholarship for grad school. They confirmed I was there to send the fax to me. I looked it over and saw it was for the entire amount of the program. You could have knocked me over with a feather. I'll have some other restrictions and requirements as a result, but my financial burden will be lessened. I was so relieved. I don't have to keep doing number-crunching to figure out how many extra shifts I need to pick up to pay for each semester. Now, I just have to concentrate on getting my work done and my schoolwork done...just like Bubba, who starts school soon. Should be fun getting into school routine after some time away from it.

More to come...stay tuned.

Heard on the unit...

Aw, it's been forever since I've had enough goodies for this segment! But when patients speak, sometimes we just bite our tongues and run as fast as we can to our lunch break, so we can share with the rest of the folks on the unit and with the audience at home.

Situation 1

RN is educating patient about the proper way to use an incentive spirometer. After demonstrating proper technique, patient says, "Oh, that's just like what I do at home with my bong." RN listens as patient describes how marijuana "relaxes my legs so I can get into my chair."

Sorry, remember that non-smoking thing you signed to come here for rehab? Yep, it applies to Mary Jane, too.

Situation 2

RN is talking to patient re: helping himself (He's a lower level thoracic paraplegic, so he can do it) by dressing and turning himself. "Oh, I'm not going to do that (turning) at home. I'll just wake her up." (implying whatever woman happens to be in his bed.)

Nice. My reply, "So since Babe #1 is not here, could you just move the pillows and turn yourself, please?"

Situation 3

From patient who is not really observant about following his intermittent catheterization rules or fluid restrictions.

"Where's my nurse? I missed my appointment." says Mr. Drinks-A-Lot.
"What appointment?" I asked.
"My catheter appointment. I've got a headache."
"Yes," I replied, "and you realize this is a sign of dysreflexia, correct?"
Patient shakes head.

If only Tom and Ray were here to do this...more to come...eventually!

Ironies

There are just some things that are very ironic in my job.

First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.

I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).

Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.

Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.

Stay tuned. More merriment to come...

It's that time of day...

...when you can say, "go on and head for the mountains."

Wait, this ain't no beer commercial! Head on over to Man-Nurse Diaries and check out the latest version of Change of Shift. And, I'm not going to spoil it, but you HAVE to read the fine print at the end. MND, you surely had fun with this one...in more ways than one!

Thanks for including me in this edition, and go crack open your favorite beverage, if you're so inclined.

More to come...

Cookin'

That's what I'm doing on my day off, enjoying the overcast skies. If I could sing on key, I'd probably pen an ode to my favorite kitchen appliance.

A little housecleaning, a little shopping and a little visiting with friends will make my day complete.

Stay tuned...it's back to the ranch soon, so more fun ahead!

Life and death

I've been lucky this week. Things finally calmed down. My first couple of days were pretty exciting.

There is always a hustle and bustle on one particular day of the week, because it's this day that we get the most patients admitted to the unit. This day also is the day I work my evening shift after a day of rest. Sometimes, I have time to get rolling and other times, I have no time at all and that was the case.

I got in and one of my patients needed blood after the first two hours of the shift. Only no one got his consent, which means I had to track down our doc, who was long gone and out of pager range, then call the local on call doc to get him/her to come over to do the MD portion of the paperwork. Said patient was a little perturbed because his favorite MD never told him he might need blood. Happily, he got over that, and I got the blood started before the end of my shift and even led one of the new nurses in the process so he/she would get some practice, since we don't give too much blood at night. All was good.

The next day, everyone's happy and I'm actually getting into my rooms right after report. In one room I smell something funny. I look and see my quad patient has bursted his colostomy. Get goodies and clean him up. I think the wafer is intact, so I get ready to put the new bag on, and discover it's not. Get all stuff set up and put on new wafer. Three sides are taped with pink tape (because he needs it) and all of a sudden I see a geyser. Thankfully, I caught it with the nearby towel. (Nursing students: never change a colostomy bag without one...if you do, do so at your own risk!) Finish cleaning, finish taping and I kept praying all night he wouldn't do that number again.

Another patient recently asked me about last rites and whether he got them when he was very ill. Since we have an active chaplain service, it was really easy to check the chart. Besides, I told him, spiritual care is also mandated by JCAHO.

One day, I came in to the news that one of our recently discharged patients had died. It was shocking, because, he/she was young and in a way, it wasn't. This patient always denied suicidal ideation, but something about him/her caused a faraway look on their face that made you think they would not be around for a long time. We often talked about ghosts and somewhat about death, because our unit has a reputation for being haunted. Said patient even stated that he/she saw something in one of the rooms he was in that lead him/her to believe that the stories were true--curtains jiggling at night, and a reflection in the mirror when no one was around. He/she wasn't worried, because he/she hoped his/her roommate, who died during his/her time was the ghost hanging out in that room, because it was comforting.

And so the week of work is ending, and the sturgeon moon is on the way. We'll just wait and see how it goes. More to come...stay tuned!

Happy Birthday Emergiblog!

Yes, today's the day four odd years ago that Kim started her blog, and the multiple minions of the nursing world, myself included, in the big and small cities, megahospitals and clinics, have followed in her much larger footsteps.

How lucky we are, since Emergiblog not only tells you about life in the ER, but also brought Change of Shift to life, which has given the world a little slice of the realities of nursing life out there.

As they say in Poland, sto lat...may you have a hundred more!

Rain!

That means no weeding for me, but at least, I don't have to water the tomatoes. Busy, busy day. More to come later this weekend...stay tuned!