Today's "Reason For Your Visit"

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

Medical Problems

Upon seeing this note, I immediately pushed this patient to the front of the triage line, as it is increasingly rare that patients coming to the ER have actual medical problems.  Take my patient a few months ago that rushed over to the ER after developing "a severe goiter in my neck and I couldn't breath or swallow anything."  You might think this patient presented in a tripod position with drool coming out of his mouth and a neck the size of a small country.  You might think I could look at his nailbeds and see the azure waters of the south pacific in those oxygen-starved parenichiums (paronychii?).  You would be wrong.  I actually found a very talkative and pleasant man with no breathing abnormalities and no distress whatsoever.  Capillary refill normal and intact, even pulses, no paresthesias and a GCS score of 187.

That is why when I see "Medical Problems" on the slip of paper, I know it must be serious.  Right?

Letter Scramble

As long as I'm on the Wordnerd kick, here is something that I find truly amazing.

I hvae seen tihs a few tmeis, but I am aywals bwlon aawy by how esay it is to raed.  The ieda is taht as lnog as you lvaee the fsrit and lsat ltetres in pcale, you can tlaltoy ranrragee all the ohetr lttrees and it is slitl redalbae.  Tehy say tihs is bceusae we dnot raed all the lrettes in ecah wrod, but rthaer sikm oevr wrods and flil in the balkns wtih our mnids.

I cnat get oevr waht the hmaun mnid can amopccislh.  It mkaes you wdneor, tuoghh, if we are so sramt, why do we siltl hvae MTV?  And why wulod my petanit form the ohetr day gvie me wtear inetsad of unire?  Taht is a qsuteoin for the aegs.

Warning: Wordnerd Post Ahead

Interesting Pile is quickly becoming one of my favorite destinations on my Google Reader dial. I only recently discovered it, but it is a site of a librarian who posts links to all kinds of lists. Top 10 this and List of 30 of that and 20 worst this. Much of it doesn't interest me, but that is a good thing because every day I am inundated with 10 or 20 of these lists, so if I just find a few interesting ones per day, it takes up much of my valuable time. If only they weren't so stinking, well, interesting.

Today, one of the links was to Bookninja - a site that I have never heard of - who post a list of the 100 most beautiful words in English from the alphaDictionary. This is according to Dr. Godcomplex who arbitrarily picked them out of his rectal cavity.

Anyway, apparently he bases this on the sound and meaning of the words, probably using the same formula that Medicare uses when determining reimbursement levels.

Of course, to wordnerds like me, I have to put my two cents in, so I went through the list and found 13 that I actually think are beautiful, based on my formula, which is "does it sound beautiful" (read: cool). To his credit, he did get my two favorite words: plethora and loquacious, and in his "bonus" section (which, interestingly, is just a continuation of his alphabetical list) mentions tintinnabulation. Otherwise, he failed miserably - Fragile is one of the top 100? Really? After muddling through his list, I went to my list (yes, I have a list - 240 words strong so far - I openly admit that I am a nerd) and grabbed 50 that should have been on Dr. Goodwimp's list but were apparently not as worthy as elixir or diffuse or glamour or ripple.

So to all my hopeless wordnerd colleagues out there, please enjoy the 13 honorable mentions from Dr. Goodlord, and then look at what a real list of wonderful words should look like.

Did I mention I'm a nerd? If not, I'm a nerd.

From Dr. Goodweird's list:

7 blandiloquent Beautiful and flattering.
20 ebullient Bubbling with enthusiasm.
26 ephemeral Short-lived.
30 eschew To reject or avoid.
33 ethereal Gaseous, invisible but detectable.
49 imbue To infuse, instill.
54 inure To jade.
62 lithe Slender and flexible.
63 loquacious Talkative.
83 penumbra A half-shadow, the edge of a shadow.
86 plethora A great excess, overabundance.
96 scintillate To sparkle with brilliant light.
100 surreptitious Sneaky.

From my list:

1. Abrogate
2. Alacrity
3. Anachronism
4. Attenuated
5. Bequeath
6. Burgeon
7. Cacophony
8. Circuitous
9. Confabulate
10. Dearth
11. Deleterious
12. Discombobulate
13. Efficacious
14. Egregious
15. Emaciated
16. Epistemological
17. Equanimity
18. Extemporaneous
19. Heretofore
20. Ignominious
21. Indubitably
22. Insinuate
23. Intrinsic
24. Juxtaposition
25. Leviathan
26. Machination
27. Magnanimous
28. Malapropism
29. Masticate
30. Nomenclature
31. Obfuscate
32. Ornery
33. Paraphernalia
34. Parturition
35. Pedantic
36. Perspicuity
37. Precocious
38. Preternatural
39. Quixotic
40. Resilience
41. Repository
42. Reticent
43. Saltatory
44. Superfluous
45. Triumvirate
46. Unconscionable
47. Unremitting
48. Vitriol
49. Voracious
50. Writhe

Today's "Reason For Your Visit"

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's get to today's Reason For Your Visit:

Heart Pains

You may think that you know who this patient is, but I assure you, it really wasn't Anne Murray.

Filler (or Braden's Musical Tastes)

A while ago, KeepBreathing at RT101 had some time and nothing constructive to do, so he shared a list of songs that he likes by putting his music list on random mode and just listing out what songs came up.

If it's good enough for RT, it's good enough for me!*

1. Richard Cocciante - Si Tu Me Revenais
2. Celine Dion - Where Does My Heart Beat Now
3. Piotr Tchaikovsky - Romeo and Juliet Fantasy Overture
4. John Williams - Theme From Jurassic Park
5. Garth Brooks - Unanswered Prayers
6. Juanes - Nada Valga Sin Tu Amor
7. Mark Chestnut - Almost Goodbye
   
8. Colin Raye - If I Were You
9. Antonin Dvorak - Allegretto Grazioso from Symphony Number 8
10. Karen Carpenter - We've Only Just Begun
11. Metallica - The Unforgiven II
12. Foo Fighters - Everlong
13. Benny - Llueve Luz
14. Francis Cabrel - Je T'aimais, Je T'aime et Je T'aimerais
15. George Gershwin - Rhapsody in Blue
16. Gerard De Palmas - Au Paradis
17. Anne Murray - A Little Good News
18. David Archuleta - Imagine
19. Howard Shore - The Bridge of Khazad Dum
    
20. Inside Out - Jackie Chan
    

Some notes on the songs:
I love youtube.  The only song I couldn't find: Boomtown by Toby Keith, so I skipped it.  My least favorite song on this list: #2.  My favorite: #5.  I went to see the Lord of the Rings Symphony performed live twice.  Amazing.  The first time while standing outside the symphony hall, Howard Shore walked right by me, but I didn't notice him until he was 10 feet past me and he pretended to not hear me when I called after him to get a picture.

* I did this with my entire music collection, but then realized that I have a lot of music on my computer that I never listen to and doesn't belong on my list, so I made a playlist with all the songs that I actually enjoy and that is where this came from.  Otherwise you would have found chapters from audiobooks and Christmas music and stuff that my wife made me rip from her CDs.  Also I hate rules, so I skipped some songs that I didn't feel like putting on the list.  Live with it.

Short Post

I've noticed that I've posted a lot of long posts lately.  Here is a nice short one to give you a little bit of a break.

You're welcome.

Why I Work in the ER

Recently we had a staff meeting where the guest speaker asked each of us to introduce ourselves and say why we like working in the ER.  Since then I've been meaning to put up a post about why I like working in the ER but laziness has had a firm grip on the better of me.

Until today.

The 2008 elections taught me many things, one of which is that girlvet and I run just about completely opposite on every political issue.  That said, here is her reasons for why she likes the ER:

TOP TEN REASONS WHY I WORK IN THE EMERGENCY ROOM
by Madness (AKA girlvet)

1) The HOURS - I work 12 hour shifts during the day. I work 5 shifts in 2 weeks. So I am off 8 days in 2 weeks. I work 10 days out of the month. I don't have to rotate. We have self scheduling. It works out good with my family.
2) My CO-WORKERS. People in ER are a fun, interesting group. They have interesting lives. They are not your everyday average Joe. Even the doctors are fun (!!)
3) Immediate GRATIFICATION. We really do help people. We relieve pain, help people breathe better, help them be less anxious, feel safe. That feels good.
4) The CHALLENGE. It is forever changing around treatments, technology, new programs within the hospital. Every once in a while something really interesting happens.
5) The VARIETY. Every day is different because every day we have different patients and they have different problems. We see people from all walks of life, in every variety humans come in.
7) SHORT TERM care. Most of the time we see people for 2-3 hours at a time and then they are gone. If they are annoying, or their family is annoying, they are gone in a short time. If they are having diarrhea or pushing on the light every 5 minutes they are gone in a short time. Only dealing with people a short time is a beautiful thing.
8) The HUMOR. Humanity always surprises. What people do to themselves. What they tell us. It keeps us amused.
9)The EXCITEMENT. After a few years in the ER when you feel confident in your abilities, critical situations are fun and challenging. It feels good that you can handle them.
10) The ACCEPTANCE. People who work in ERs can be quirky, different. We are an accepting sort. You can be a big of an oddball and its all good.

I have nothing to add to this list.  The only difference is in my schedule - I work a variable schedule, which means that I pick from the unfilled shifts after everybody has been assigned their normal rotations.  This generally works out well for me and I get to work mainly day shifts.  Otherwise, we are in complete agreement on why we love the ER.

Now if we can just get the ER to run for President.

On Tipping

A few months ago, Voodoo Medicine Man brought up a story about trying to tip at a restaurant in New Zealand.  Turns out that you don't tip in New Zealand.

I am a fan of being able to tip for service-related jobs, but I hate how it has become expected.  While the etymology of the word "tip" is debated, the idea of a tip is a "gratuity" (as in a way to say thank you) or in French a "pourboire" (literally: to drink).  When I go out to eat and I get really good service, I like to reward that service with something extra.

Extra.

I'm lucky to live in a state where all servers have to be paid at least minimum wage, and then they can supplement that with tips.  States that have no such laws are ridiculous.  I know that when my wife and I lived in a mid-eastern state a few years ago, waiters and waitresses made a buck-something an hour plus whatever you tip them.  That is just silly.

But for the sake of my argument, I'm going to talk about tipping as an extra, and not as a base wage.

I hate that we have linked our tips to the price of our food.  Is it really any harder to bring out a plate of lobster bisque than it is a bowl of soup?  No.  So why do we add 4 dollars to the tip for lobster and 1 dollar for the soup?  Tipping should be based on performance - not cost.  When I go out to eat, I expect to get my meal brought to me in a reasonably timely manner and have my drink refilled occasionally.  This is the very basic core of hospitality.  A server who provides this level of care for me will get a very basic tip.  A server who is prompt to the table, provides courteous care, observes and anticipates our needs before we have to call for them, and shows kindness, humor, and consideration can expect to get a big tip.  It is very rare for me to leave no tip at all, but it has happened when we get a server who completely ignores us for long periods of time, who displays an attitude when I order a water (I almost always get water with my meals not for cheapness, but because water is healthier than other drinks and doesn't take away from the flavor of the meal.  I can get root beer at home.  I'm not at the restaurant for the root beer - I'm there for the grilled chicken pasta or the salmon fillet.), or who messes up on the order and is unwilling to simply say "I'm sorry" - the basics of customer service.

I'm not sure why it is so hard to take each hospitality situation as an individual situation and tip accordingly.  When K and I were honeymooning in Fort Lauderdale, some guy at the airport asked if we were going to get a cab.  We said yes, so he waved with his right hand to a cab about 50 feet away.  When the cab showed up, he put one of our suitcases in the trunk and then held his hand out and said, "we works for tips."

Sorry, sir, but a tip goes to someone who does something for me that I can't do for myself, and for someone who shows that they are willing to go out of their way to serve me - for someone who makes me believe that they are there for me and not the other way around.

I've left huge tips for 6 dollar meals and I've left a dollar for huge meals.  Someone asked me once, "why don't you just leave 15%?"  My answer: "Why doesn't Tiger Woods just carry a 9 iron to use on every shot?"  Every situation is unique and should be handled as such.

Oh, and on another tipping subject: I appreciate that you put my happy meal together, but I am not going to give you a tip for standing at a counter and putting fries in a bag.

So in the end, after all my meandering ramblings, I guess what I have to say is that I like the ability to give a tip.  I don't want to live in an area where it would be considered insulting to give a token of gratitude, but I really hate what tipping has become in our culture.

Anyway, if my waiter deserves 5 bucks for bringing me a plate of food, why can't I get 15% of the ER bill for saving someone's life?  Chew on that one for a while.

Chesley "Sully" Sullenberger

Like most people that I have talked to, I was quite taken by the story of flight 1549 when it occured.  The more I read and learned, however, the more I realized that what happened in New York was a true miracle, and the captain of that plane is a true hero.

He recently spoke to a crowd in his hometown.  His speech lasted about 30 seconds, and basically he said, "we were only doing what we were trained to do."

Well, Mr. Sullenberger, millions of people every day go out and do what they were trained to do in jobs all around the world, and any pilot in your situation would have done the best they could to land the plane safely.  That doesn't make a hero; but what you did goes beyond training.  The technical skill of being able to harness enough control of a failed aircraft hurtling toward ground over a heavily populated city can be taught, though I wonder if many other pilots could have landed so successfully with so little time.  What sets you apart, sir, is that you took no thought for yourself, but instead did all within your power to make sure that every person on that plane made it out safely, and they did.  We always hear of the proverbial captain ready to go down with the ship.  You made that proverb a reality.  The combination of expertise, quick thinking, and selfless generosity that you displayed is not something that anybody can be trained to do.

You may look at this situation and think that you were only doing what you were trained to do, and wonder why you are being hailed as such a hero.  After all, it was just one event - five minutes of your life.

But it is not those few minutes that makes you a hero.  It is the years and decades that came before and that shaped you, and made you a man willing to give his all for others; a man who is genuinely surprised when his actions earn him such accolades; a man who thinks that everybody else would have done the same thing because being willing to sacrifice for others is the only thing he can think of - that is what makes you a hero.

I'm sure you have your heroes that you look up to for their great deeds.  Perhaps, like me, you watch superhero movies and wish that you could foil the supervillain or stop the bomb from exploding or divert the asteroid heading for earth.  Most of us will never get the opportunity to be tested in so dramatic a fashion.  Each day we clock in to our daily routine and do what we are trained to do.  When the whistle blows we head home and get ready for the next day's routine.  We do what we are trained to do, but we long for the greener grass that is just beyond our reach where we can stretch ourselves and make a real difference.  We long for it, but we go back to the routine, because our dreams are the stuff of fairy tales and hollywood movies, not our boring lives.

That fateful thursday morning, you were just another face in the crowd as you walked through the airport and punched the clock on the wall.  Yes, you had those shiny gold wings on your chest, but they were no shinier than the day before.  Indeed, this was just another day for you to show up and do what you were trained to do.  Fortunately for 155 people on that plane and millions of Americans watching the news, your training went beyond what you learned in the classroom and on safety training day.  You showed us that every day that we clock in for work, we can do it with a mindset to do the most good, that we can sacrifice what we might want for what is best for others.

Mr. Sullenberger, when I think of the Captain who calmly turns on his best skills to make a nearly impossible landing, and to make such a landing so smoothly that a flight attendant thought that it was a runway landing, I am impressed.  When I think of a man who makes such a difficult landing because the easier route would have risked a crash in a populated neighborhood, I am touched.  When I think of a man who sees his plane filling up with water, but walks the cabin twice to be sure that everybody made it out safely before he thinks of getting himself out, I get tears in my eyes.

Please do not be surprised as letters and cards and prayers of gratitude come pouring in.  They are not just thanks for 5 minutes of calm leadership; they are thanks for a lifetime of service that lead up to one of the best examples of emergency leadership of our time.

Thank you Chesley Sullenberger.

Today's "Reason For Your Visit"

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.

So let's start off with today's Reason For Your Visit:

sick

That's right - this patient wanted me to be aware of the extent of her problems, so she took great pains to delineate each and every complaint in painstaking detail.  Sure, it may just look like four letters to you, but to an experienced triage nurse it is so much more.  To a triage nurse in a busy ER, these four letters are explicit permission to skip over this patient and take care of the one with right lower quadrant pain.  She may complain, but I have four letters that might help explain the Reason For Your Delay:

busy

Jenna and Barbara Bush

It is comical now to look back at the wild predictions that were made by some of the lunatics on the left fringe (yes there are lunatics on the right fringe, too) about how Bush would declare marshall law and turn himself into a dictator and not relinquish control of the White House when it came time.  It is sad that some people actually believe that.

In fact, the Bush administration was remarkably coordial and helpful with the transition of power and went out of their way to ensure a smooth turnover.

But today I think I saw the best of the Bush family.  If you haven't already seen it, go read the letter by Jenna and Barbara Bush to Sasha and Malia Obama.  The Bush twins are now 26, but they have a shared bond with the Obama girls, and their letter is a very human and wonderful letter and you can feel the sympathy of the Bush girls as they try to welcome the Obama girls to what is surely a very lonely yet exciting life.

I especially enjoyed the last paragraph:

And finally, although it's an honor and full of so many extraordinary
opportunities, it isn't always easy being a member of the club you are
about to join. Our dad, like yours, is a man of great integrity and
love; a man who always put us first. We still see him now as we did
when we were seven: as our loving daddy. Our Dad, who read to us
nightly, taught us how to score tedious baseball games. He is our
father, not the sketch in a paper or part of a skit on TV. Many people
will think they know him, but they have no idea how he felt the day you
were born, the pride he felt on your first day of school, or how much
you both love being his daughters. So here is our most important piece
of advice: remember who your dad really is.

I respect that kind of grace.  Surely they disagree with Obama's politics, but they respect him for who he is to his children, and that is a Dad.

And whether you are a nurse or the president, there is no greater title a man can have than Dad.

Victim Shortage

I was reading through interesting threads on allnurses.com and came across one asking about the nursing shortage.

Markas214 just happened to have posted a stupid liberal rant right before I got there, so I composed a response, and then decided to just put it here and leave the forum alone.  Go read his tripe first, then I'll put my comments up.
You back?  Good.  Here's my response to markas, though it may never get to him:

"...When i started it was a lull in hiring..."

Markets rise and markets fall, but if the politicians can keep their hands out of them, they always correct themselves in the end.  Just like 14 years ago there was a lull, there is a lull right now.  It will reverse itself and after these lean years, there will be years of plenty.  It was that way in biblical times, it was that way 14 years ago when you started, and it will be that way now.

I just hope that these scare tactics being bandied about on the left don't succeed.  I find it the ultimate irony that with one side of their mouths, these liberals can accuse the republicans of ruling by fear with the war on terror, and out the other side can tell you about the doom and gloom that is upon you in healthcare and whale-saving unless you do exactly as they say.

Markets rise and markets fall, jobs come and jobs disappear, money is made and money is lost, temperatures rise and temperatures fall, wars rage and peace reigns.  We live in a cyclical world.  Stop panicking.

"Arizona has absolutely horrendous unemployment compensation. $250/week. Try living on that after earning near six figures for the past several years..."

Go to worldsalaries.org and look up the monthly salary of a working nurse in the Philippines or Thailand, or do a Google search for the average world salary and let me know if you still think 12,000 dollars a year to do nothing at all is still horrendous.  I'm sorry to burst your entitlement bubble, but when you are making almost double the average world salary without lifting a finger, I find it hard to feel sorry for you.  So you got used to the good life and started living beyond reasonable means.  That's great.  It means you should have plenty of investments to sell in order to stay afloat.  Perhaps you could sell the 30,000 dollar car and buy one on craigslist for a couple grand that has better gas mileage anyway.

"...We are all the victims..."

That's right!  We are all victims and wo is upon us!  It isn't our fault so we shouldn't expect to have to do anything at all.  It's okay because grampa government will step in and save us, after all we are victims!  I know I'm a victim - after all, I'm a male in nursing and everyone else around me has long hair and boobs.  When I go to buy scrubs, I only have one rack of scrubs for me next to the dozens of racks for the females.  I'm a victim and I demand reparations.  President Hopenchange, please cut me a check right now.  I want the money I'm entitled to!

Markas, go grow some skin and stop being a victim.  Pull yourself up and get to work.  If you are worried about money, then go out and invent a new product, start a business, learn a new skill, ask a family member to help, get some help from your church.  Help yourself, and when that fails, get those who have responsibility to help you to get involved.  Stop looking for handouts from the government, and for the sake of all that is holy, stop looking your gift horses in the mouth. Every time the federal government gets its dirty, greedy, inefficient, bureaucratic hands tangled up in the free markets, things just get messed up more and more.  Sometimes you just have to let a cycle be a cycle.

Oh, and this is not a political rant.  It's just a statement of absolute fact.

Cojones

She had a simple complaint of groin pain at her surgery site, but something just wasn't right.  First her pain kept subtly changing, but more concerning was the pulse of 130 with irregular pupils and BP through the roof, so we ask for a urine sample, ostensibly to check for signs of kidney stones, but also to run an SAS.

"But I can't go.  Maybe if you bring me some juice."

Apple juice, coming right up!  When, a while later, the pulse is still up there and still no urine, I start an IV and start dumping normal saline in.  Finally, she can go to the bathroom, so I walk her and her new friend Mr. Ivey Pole down to get a urine sample.

A few minutes later, I'm sitting at my desk going over a chart when she walks up and says, "here's the urine sample."

This is what she hands me:



Yes, that is a photo of the actual "urine" I was given.  Interestingly, this patient, who had to have juice and IV saline to be able to produce urine, has some kind of kidney disorder in which she produces completely clear, cold urine with a specific gravity of 1.00 and a pH of 7.

Unfortunately for my dear patient, the doctor is ex-military and not interested in the publishing rights to the ground-breaking case of the patient with hydrofrigourinosis.  Instead, the patient got a consolation prize of a good swift kick in the rear end and don't let the ambulance hit you on the way out.

Don't play games with these ex-military types... and if you are going to play the game, at least try warming the tap water up before putting it in the specimen cup.

This Atropine Ought to Slow Your Heart Down Nicely

I was at the nurse's station enjoying just a moment to rest as all of my patients were in holding patterns and had nicely fluffed pillows when the triage tech came back announcing that they need a room now.  I go to help clean room 20, and since I wasn't doing anything stayed to help with the patient, an elderly gentleman with a BP of 70 over crap who was diaphoretic and complaining of general malaise.  We got him hooked up to the monitor and got a line started and looked up to see a heart rate of 188 in clear SVT.  History revealed a pattern of this, worsening over the past few months.  According to the daughter, it had responded well to adenosine in the past, so we decided to do that again.  6 mg in, and we all waited and watched the monitor as the patient groaned and complained.  No appreciable change.  Try again with 12.  We all wait, holding our collective breath as the monitor does nothing nothing nothing, and suddenly flatline... and... return of normal sinus rhythm in the 60s.  We turn to the patient and ask how he is feeling and get a positive report.

General relief is felt everywhere as we continue to watch the monitor and see the rate get irregular and start to fluxuate and move up to 80, 100, 130, 185, and from the bed we start hearing complaining again as the SVT sucks the oxygen right out of her.  I look over at the chart and realize that nobody has been charting and now the doctor is ordering for Cardizem.  I take pity on the primary nurse and grab the chart and start to try to catch up with charting everything that has been going on.  People are throwing times at me from every corner of the room: EKG done at this time, IV in at this time, meds given at this time, Obama inaugurated at this time.  I'm frantically trying to get it all down before my porous memory starts gushing, and if I do say so myself (I do), I do a mighty fine job.

A minute later my lunch breaker shows up and I leave to give him report.  From the room, I hear someone calling: "Braden, please get in here!"  The tone lets me know that I'm in trouble.  I can't imagine what I did wrong, but in I come to find a chart shoved in my face.

"Care to change the medication?" asks the primary nurse.  Wondering what he means, I review what I wrote to find that I had charted that we gave 12 times the normal dose of atropine to an SVT patient, followed by 24 times the normal dose, just to make sure the rate hits 500.

Oops... perhaps I meant to write adenosine.

The Presidential Race

I'm going to apologize ahead of time if this rant seems random - my thoughts are scattered, but I feel I need to get some of them down.

I also apologize if anything I say gets misconstrued.  Talking about race is always a dangerous subject, so let me say first and foremost that I am not at all racist and nothing that I say should be interpreted as such.  If it seems like I am saying something that would belittle anybody else because of their race, then please accept it as a poor communication because I do not harbor such feelings.  That said, here are my thoughts:

Martin Luther King day and the inauguration of our countries first minority president fall very nicely together.  As any regular reader of my blog is aware, I am fairly conservative and I have great reservations about President-elect Obama's positions and viewpoints.  I didn't vote for him, and given the chance, I'd go and not vote for him again.

When it came time to select my President, skin color is not a part of the equation.  I live and work around blacks and whites and gays and straights and Latinos and Asians and men and women, and I love them all.  I try very hard not to stereotype anybody but instead to take them one at a time and give them the benefit of the doubt while I get to know them.  I think that a little bit of bias is built in to the human condition, but for the most part it is easy to overcome.  Certainly anybody who refuses to vote for somebody for political office, or who refuses to support them once elected based on race is somebody who needs to take a deep, long look into their conscience.

Senator Obama said many many times on the campaign trail that he was trying to stay away from race as an issue in the campaign, and despite a few obvious slip ups ("I may look different than the presidents on our dollar bills...") it seems like he did so (of course, there is no way to know how much he had his hand in the mountains of race baiting that happened all around him, but I'll take him at his word here).

But when you have the first seriously contending African American (yes, Nurse K, I know he is actually bi-racial, but I'm simplifying) running for president, it is not possible to escape the race issue.

On this day that we celebrate Martin Luther King's dream of a nation where we will not be judged by the color of our skin but by the content of our character, I stand with great pride about how far we have come as a nation, where Colin Powel and Condeleeza Rice and Tiger Woods and Denzel Washington and so many others have paved the way for the great American dream to be open for all.  And yet, I stand with great fear for the future of race relations in our country when I watch television stations like BET further stereotypes of unlearned, immoral, womanizing criminals being the standard for blacks to look to, or when I see so-called leaders like Al Sharpton and Jesse Jackson, who jump on any chance to sensationalize and alienate and turn any situation into an us vs them, and in so doing keep race relations held back.  I feel great anxiety about where we are headed when I see the videos of Reverend Wright and those like him who would perpetuate the victim mentality, and rally the troops for a false war.

My nominee for hero of the black cause so far this century is Bill Cosby.  He has not been afraid to deal the hard love that needs to be dealt.  So much of cleaning up the problems that persist in black communities is to take personal responsibility for becoming a contributing and successful member of society.  These are principles that apply to every group of people, be they black or white, religious or atheist, nurse or doctor: learn everything you can, respect those around you, live morally, work hard, and eschew the title of victim.  What made this nation great to begin with was the mentality to stand up and do what is right and when life gives you a lemon, go find some sugar, butter, flour, and eggs, and make really good lemon bars.

That is why I respect Obama and have hope for what his Presidency can mean to race relations.  At least to this point, he has not tried to sensationalize race.  He has shown that a black man can be true to himself and be educated, well-spoken, and successful.  There is no need to try to be like P-diddy or Tupac in order to be true to your race.  We need to celebrate that.  We need to celebrate when a Tiger Woods can come along and make a big name for himself in a white-dominated sport.  We need to cheer when Condeleeza Rice can take on one of the most important jobs in the land and carry out the task with dignity and honor (partisanship aside).  I think having such a role model (partisanship aside) as Barack Obama in the most visible position in the entire world can take race relations forward by leaps and bounds.

And yet I'm scared.  I'm scared because all around in the background we have seen so much negative race baiting.  If we are to truly move forward in this country, then we need to put the charges of racism aside and work together.  It is an unfortunate reality that there are some people who would still judge a man based solely on the color of his skin and make assumptions and treat him as lesser.  That said, the overwhelmingly vast majority of people in this country are ready to accept that there is nothing about being black that makes a person less capable than a counterpart of any other race.

So in some roundabout way, this kind of gets me to the point that started this whole post in the first place: We will go backwards precipitously in this country if we continue to allow race to be used as a weapon.  I have seen throughout the campaign as charges of racism were leveled every time a major criticism of Obama was layed out.  This has to stop.  Period.  Vigorous debate is a fundamental part of the foundation of this country.  Principles such as freedom of the press and the first amendment are so important to us because it allows us to embrace conflicting viewpoints.  This is how we come together to share our differences and in so doing move toward common ground.  When this kind of free intercourse (stop giggling) of communication is allowed to thrive, then we thrive.  When it is stifled by wild acusations of racism, not only do we lose out on the discourse that could have been, but we devalue the true conflicts - the ones that actually have significance and impact.  Building straw men out of race and then tearing them down is a danger that should not be underestimated or pushed aside.  Cutting off debate with charges of racism halts the free distribution of ideas, and we are a nation powered by ideas.

Barack Obama is not the promised Messiah, but perhaps he can be, by nature of his office, the bridge that the civil rights movement needs to cross the trials that it faces.

Enjoy the historic day tomorrow as we see a symbolic step forward in equality for our nation and a giant leap toward Dr. King's dream.  Then put race away on the shelf and move forward doing your part and your duty and continuing the honest and free debate that helps make this the greatest nation on earth.

reel phat wurdz

On an internet forum a while ago, I saw a post complaining about how hard it is to understand what people are trying to say because more and more colloquialisms are showing up where more formal writing would be more appropriate.  The poster goes on to lament the increasingly common uses of abbreviations and abuses of grammar and spelling.  Mentioning to/two/too and there/their/they're and know/no as some examples of common mistakes that supposedly educated adults are using.

How about loose for lose?  There is a motivational poem up on the bulletin board at my work with the last two lines saying: "never loose faith/but mostly have fun".

Don't worry, I'll hold my faith very tightly so that it doesn't get all wobbly, and I'll mostly have fun, but sometimes I'll be grumpy.  Or perhaps they really meant: "never lose faith/but mostly, have fun," which I guess would make more sense.

I don't mind so much the abbreviations for things as I do the lazy spellings.  We are raising a whole generation of kids who think that you is a one-letter word.  I don't always use the Queen's English, and I add plenty of slang into my conversations, (saying peeps for people brings joy and gladness to my day) but you can understand me when I speak and when I write, and I think that is basic communication.  The good news is that as more and more people get lazy with their communication, there are more and more resumes ending up in the trash and therefore more job opportunities available to me.

cuz if i right like most ppl u probly wont no what im sayin 2 much. thats cuz we r gettin real lazy bout learnin r kid's. but aks an adult and they cant spel to. they get pwnd!!!!!

I guess, though, that in the end, I'm just grateful that I have yet to see a note on the medical record that says "OMG she b real phat, but dnt want pills til 2moro. i aks her if she b mental and say u noe u gots ta take it 2night cuz 2moro is majorly 4eva away. ;-) she say k thx and ate teh pill. thats gr8 innit?"

Sure, If You Are Paying

Over at WhiteCoat Doesn't Rant Anymore, we learn of a fascinating survey by the Kaiser Family Foundation that pretty much describes most liberal ideas: it sounds great until you inject reality.

It turns out that most Americans want universal coverage for health care that is paid for by thier employer or the rich, but support drops considerably if you mention that, oh by the way, you are going to have to pay for this.

WhiteCoat concludes:

In summary, it seems that most people in the survey want “The best health care someone else can pay for.”

Yup, and while you are at it, I want a pony.

Please.

Reason for Visit of the Day

I worked triage again today, and the hands-down winner for best entry in the "reason for visit" line of the paper patients fill out when checking in:

my head poped

I hate it when that happens.  Luckily, a few royal men and horses were able to get together with a roll of duct tape and some crazy glue and solve the problem.

Runner-up:

emergency

Thanks - that's really helpful.

Heart Attack Cake

Courtesy of Cake Wrecks comes this, the greatest cake ever made.

Somebody please tell my wife that this is the cake I want for my birthday.

Medication Spelling of the Day

Among a number of minor misspellings on a hand-written med list (including daly 4 times and dayly once) was:

hydrochorot

Hydrocodone?
Hydrochlorothiazide?
Hydrocortisone?
Hydro-Cobex?
Hydrochloric acid?

No Pharmacy Tech

So the doctor orders a smog enema, which has to be made at pharmacy.  I go up to the ER pharmacist, who gets paid a kajillion dollars a year, and show her the order and she says, "okay, but we don't have a pharmacy tech tonight, so I'm going to have to make it myself, and I'm not sure how, so it will take a while."

Go hug a pharmacy tech today.

Quote of the Day

From Happy:

"Doctors save lives.  Nurses save doctors and lives."

Change of Shift is up

The latest Change of Shift is up over at Crzegrl.  Emily has chosen a theme that I can certainly relate to: "If it isn't late, I didn't do it."  She also has a whole host of links, including several first-time submitters. Oh, and a link to a post of mine.  Yay.

Go check it out for the links.
Go check it out for the sarcasm.
Go check it out for the introduction video.
Go check it out for old time's sakes.

But whatever you do, go check it out.

The Best Nurse I've Ever Had

By no means am I the most experienced nurse around.  I graduated in 2007 and I've only been an ER nurse for a year.

I'm certainly not the most knowledgable nurse I know.  In fact, I've tagged a few nurses in my ER that I can go to when I have a "what on earth was that" moment.  They usually know the answers and keep me in line.

I'm not the fastest nurse around.  In fact, sometimes I can be pretty slow because I still second-guess myself (was I supposed to mix that with bacteriostatic water or saline?) and when setting up for procedures I can never seem to remember all the supplies (oh yeah, I guess a speculum would have helped for the pelvic set up).  I've been making efforts to keep my secondary exams focused, but my OCD self just can't leave that height and weight box empty even though my patient is here for a stubbed toe.

I really can't say that I never make mistakes.  Sometimes I look at a chart after a patient has left and think, "I hope the lawyer doesn't see that."  I forget to go and get the cup of ice and the extra blanket that I promised.  I treat a patient for three hours before realizing that they don't have a name band and I've given several medications.  I miss more than my share of IV sticks.  I almost always show up 1 minute late no matter what I do.  To save my life I can't remember the name of the patient in room 23.  I had a nurse ask me if I had charted the black eye on that patient who just got shipped to the level 1 hospital... I hadn't even noticed it.

So why is it, then, that I have had many patients say to me: "you are the best nurse I've ever had"?

I don't say this to brag - if I wanted to brag I wouldn't admit to all that stuff up above - but because I think that maybe I've found my nursing superpower: empathy.

I care about my patients.  Yes I get frustrated with the patient who is here for the third time this week for chronic back pain, but I can still go in the room, listen to their story, hold their hand, and be polite when I tell them that all they are getting is ibuprofen.

The other day I had a patient in for a migraine headache, so I went through the standard migraine fare: IV, Toradol, Benadryl, Compazine, lights off, rest for an hour.  Somewhere along the way a question I asked her raised a red flag so I dug deeper and found a history of drug problems and concerns about her children and problems with stress.  I sat at her bedside for a few minutes and offered some words of encouragement, I found the social worker and asked her to go talk to the patient, and I followed up a while later to make sure that everything was taken care of.  We talked for a little bit and hammered out a list of goals for the patient to work on to get life back on track.  When we were done she said, "every time I've ever come to the ER, everyone just rushes in and out like I don't exist.  Thank you for treating me like a person."  Another guy the same day came in with a University of Texas sweater on, so while I was starting the IV, I chatted with him about who would win the OSU-Texas game and what he thought of USC's defense.  He thought I was an angel.  A few months ago I had a patient who was a little rude, but I did my best to treat her well and to carefully explain the doctor's decision to not give her narcotics.  She got mad and came out of her room and started swearing and yelling and security was called.  Somehow I talked her down and managed to escort her and her threats of lawsuits out before security got there, but I felt like a failure to have had so angry and difficult of a patient.  When I got back, the charge nurse pulled me aside and told me that the patient was a very frequent flier (I hadn't met her before) and this was the calmest and best behaved anyone had ever seen her.  No less than 4 nurses stopped to congratulate me on how well I had handled her.

I really didn't do anything special.  I don't have to.  I have found that when it all comes down to it, most of the patients I see don't want a nurse who can recite the top ten side effects of venlafaxine.  They want a nurse who validates them as a human.

I'm not trying to belittle the technical skills and knowledge that are required to be a successful ER nurse.  A satisfied dead patient is still dead.  And I love the rush of working as a team to save a sinking patient, the satisfaction of getting a patient off to the cath lab to stop the heart attack, and the challenge of determining the correct rate of complicated medications.  I'm trying hard to become the best I can at starting IV lines, accessing ports, inserting catheters, remembering which medications are compatible, remembering to chart everything that the lawyers want me to write, and catching the subtle but important clues when assessing patients.  I have a long ways to go, and I get frustrated and anxious and overwhelmed and a little bit mad at the drunk who is running around in his underwear.  And if I could make an honest list from among the nurses in my ER of who I would want working on me when my heart stops beating, I'm not sure that I would be in the top 10.

I'm nowhere near a perfect nurse, but I am a good nurse, and my patients love me.  I certainly do not have the market cornered on being a "best nurse", nor do I want to.  My point is not to lift myself up.  My point is to say that anybody can be a supernurse.  Next time you go to work, take just an extra minute to tell a joke, hold a hand, offer a hug, ask the kid when his birthday is, put that necklace in a baggie so it doesn't get lost, and stop by the ICU after your shift to see how your patient is doing.  Not only will it make your patients much happier, it will reflect well on your facility, and it will make your job feel so much more rewarding when that patient looks at you and says, "You're the best nurse I've ever had."

Good Job, Bad Job

Interesting Pile is quickly becoming one of my favorite blogs.  Nothing fancy there, just a lot (I mean it, a LOT) of links to interesting sites - mostly lists of top 10 or 20 such and such.  Usually fascinating, always a big time-eater, I've quite enjoyed following this blog.

Today, he linked to an interesting article on careercast talks about the best and worst jobs in the US, with criteria ranking them based on stress, work environment, physical demands, income, and outlook.

Most likely due to the stress and work environment, nursing didn't do so well, coming in at number 143.  Some other medical careers that ranked higher than nursing: medical records, secretary, dental hygenist, social worker, pharmacist, podiatrist, optician, psychologist, psychiatrist, dentist, orthodontist, physical therapist, respiratory therapist, and general practice physician (by one ranking).  A few that came even further down the list: physician assistant, surgeon (309,000 per year, but lots of stress), undertaker, CNA (number 173) and LPN (number 184).

Oh yeah, there's one more even further down: EMTs didn't fare so well.  They made 5th place on the list... of worst jobs - mainly for being a low-paying (26 grand average), high stress job with a terrible work environment (as if the car accidents weren't bad enough, then they have to deal with the ER nurses).  So that's why we have cookies in the EMT charting room...

Drug seeker didn't make the list.

Interestingly, those math nerds that we all gave wedgies to in middle school (yeah, I know - ironic coming from me) have the highest ranking jobs.  And my brother who is pulling in 6 figures writing computer code is up there pretty high as well.

Why Doctors Get Away With It

I remember a big deal a few years ago when Britney Spears or some other celebrity went to a hospital and when they looked at the electronic medical record chart views, they found that something like 70 different people had looked at her chart, so they went through and determined which were legit and which were the "looky-loos".

I remember hearing that a lot of ancillary staff and a few nurses were fired, but none of the doctors.

Just today, I was reading on a story on a forum about some medics that lost their license when doing a c-section with step-by-step guidance by a physician on a peri-mortum woman.  The physician was reprimanded, but nothing more.

Nurses like to tell stories like this because it makes us feel like victims, and here in the United States, there is no more prestigious status to aspire to than to be a member of the Victim Class.  But why is it that doctors can get away with so much?

Well, the stats that Whitecoat found paint a pretty clear picture.  A huge study of 13,500 adults found that more than 87% of patients choose a hospital based on what doctor is on staff there.  So even though some doctors act like large gluteal clefts, management will still bend to their whims and personality deficiencies quirks because they know where business is coming from.  Certainly not from being a "top 100" hospital*.

So, fellow nurses, next time you want to complain about that jerk of an ENT surgeon, think about how many patients you bring to the hospital, and you'll get a good idea about which side the hospital is going to take.



*  Speaking of which, how is it possible that every one of the 4000+ hospitals in the United States are "top 100" hospitals?  I didn't take much math (why do you think I went into nursing?), but something doesn't seem to be quite right with that algebra.

Today's Medical Word

Today's great medical word is asthenia.  I would tell you all about it, but I just don't have the strength.

Answers To Life's Difficult Questions

Okay, so I was tagged for this by shrtstormtrooper over at New Nurse Insanity (and by tagged for this, I mean, she posted it and I stole it.) so here is my version.  First the rules:

1. Put your media player on Shuff​le.​
2. For each quest​ion,​ press​ the next butto​n to get your answe​r.​
3. You must write​ down the name of the song no matte​r how silly​ it sound​s.
4. Put any comme​nts in brack​ets after​ the song name.​
5. Tag at least​ 10 frien​ds.​
6. Anyon​e tagge​d has to do the same,​ becau​se fun point​lessn​ess sprea​ds like a virus​.​
7. Ignore rules 5 and 6.  They are dumb. (okay, I added that one)
8. Rule number 3 kinda sucks, too.  Instead, keep going until you find the first song title that makes an interesting answer (even if it isn't accurate).
9. If you obey rule 8 then you don't really need rule 4.  It is more fun if people can figure it out for themselves.
10. No random and pointless meme shall have less than 10 rules.

If someo​ne says,​ "Is this okay?​"​ You say?
Sold (John Michael Montgomery)

How would​ you descr​ibe yours​elf?​
I Can't Dance (Genesis)

What do you like in a ​girl?​
You've Got a Friend (JT!)

How do you feel today​?​
I Won't Last a Day Without You (Karen Carpenter)

What is your life'​s purpo​se?​
Rocket Man (Elton John)

What is your motto​?​
Remember The Time (Michael Jackson)

What do your frien​ds think​ of you?
I Get Carried Away (George Strait)

What do you think​ of your paren​ts?​
I've Got a Lot to Learn (Brooks and Dunn)

What do you think​ about​ very often​?​
Motown Philly (Boys II Men)

What is 2 + 2?
Romeo and Juliet (Piotre Ilyich Tchaikovsky)

What do you think​ of your best frien​d?
Hip Hop Hooray (Naughty By Nature)

What do you think​ of the perso​n you like?​
A New Hope (John Williams from Star Wars)

What is your life story​?​
Allegro Con Brio (Antonin Dvorak from Symphony number 8)

What do you want to be when you grow up?
The Devil Went Down to Georgia (Nitty Gritty Dirt Band)

What do you think​ of when you see the perso​n you like?​
Much Too Young (Garth Brooks)

What will you dance​ to at your weddi​ng?​
Goodbye Says it All (Black Hawk)

What will they play at your funer​al?​
Mo Money Mo Problems (Puff Daddy)

What is your hobby​/​inter​est?​
Learning to Live Again (Garth Brooks)

What is your bigge​st fear?​
Walkin' Away (Diamond Rio)

What is your bigge​st secre​t?​
You Raise Me Up (Josh Groban)

What do you think​ of your frien​ds?​
It's So Hard To Say Goodbye

I tried doing this straight through as the original rules instructed, but only a couple of them were actually funny.  I find it much more satisfying to bypass the answers that make no sense and go for ones that make me smile.  Live with it.

So now it's time for me to tag some people.  Umm... I tag... you.