Hx of Abx

Ancient Greece

Nurse's Note:  Ancient Greeks really DID put moldy bread into wounds.  Who comes up with this?

On Being a Male Nurse

At least once per week since the first time I entered a hospital as a nursing student, I hear this question leave a patient, family member, or other visitor’s mouth, “Why aren’t you a physician?”  This is such a harmless and easy question to answer…right?

Many quips quickly enter my mind in rebuttal of such a question.  I believe many forget the importance of the care that they or their loved one receives under the diligent eye of a good nurse.  It is a nurse who notices the slight decline in your blood pressure or change in other vital signs, which may signal a deterioration in your wellbeing.  It is your nurse who will phone the physician, may he or she have an educated inkling you are beginning to stray from the current plan of care.  It is your nurse who will tirelessly perform compressions if your heart may happen to stop during your stay in the hospital.  It is your nurse who advocates your wishes to the physician.  It is your nurse who does all of these things while still managing to pass and hang your medications, change your bed, comfort you in times of despair, and explain medical jargon to you in a more understandable manner.

Yes, nurses still do clean you up after you’ve had an accident in such a way as to keep your dignity intact as possible.  But, if you believe this is all your nurses do while working their twelve-hour shift, please see above.

Nurse's Note: Asking your nurse why he or she is not a physician is not a compliment.  It is insult to your nurse and to the profession of nursing.  Next time this thought enters your head, please, keep it to yourself. 


Camille says:  Here's a quiz to see if you have been paying attention!  Examine these rough line drawings carefully and see if you can determine which is the nurse and which is the physician:

1.

2.

3.

(actually, I don't know the answer either, I just wanted to draw pictures of naked people)

I Love Cigarettes!

I think cigarettes must have been invented by a doctor or a nurse.  They are the best job security imaginable for us.  I love the tobacco industry!   Every day I go to playgrounds and give out cigarettes to children.  


                                                        

I need job security!  I need the hospital to be jam-packed with patients every day!  I want there to be ambulances and wheelchairs lined up around the block!   Cigarettes are a nurse's best friend!

I have an enormous mortgage. 

Sometimes, I look around at my house, my land, my horses and all my possessions and it hits me that 90% of it has been paid for by smoking-related illnesses.  That thought makes me feel just a bit better when I see a woman with a cigarette hanging out of her mouth yelling at her kids, or some twentysomething puffing away,  desperate to appear non-desperate, or a truckload of colorfully tattooed teenagers lighting up.

We'll keep a bed for you.

Why you are going to end up in a nursing home

Do you know what humans fear the most?

Snakes?

Nuclear war?

A zit cropping up on your nose right before a big date?

No...no....none of those.  What humans fear the most is that they are going to end up in a nursing home. 

I wish that I had a nickel for every person who has told me, "I will NEVER go to a nursing home!  I would kill myself first!"

Yeah.

Medicine has allowed humans to outlive our useful lives.  When we have strokes and heart attacks that disable us and make it so we can't walk, feed, toilet and care for ourselves, we are SUPPOSED to die.  That is what nature intends.  But, we humans have our terrible fear of death to contend with.  So, we go on and on, in and out of hospitals for staggeringly expensive health care; a PEG tube is placed; a tracheostomy tube is placed; surgery, drugs, on and on and on.  Long past the point when our dementia and disability have rendered our lives less than useless. 

We become a burden to our family and society. 

Writing this is not going to get me elected to public office, but this is something we all know but no one has the courage to say. 

But, aren't we saying it, actually, when we exclaim vehemently how WE will never end up in a nursing home?  WE are different, WE are the exception.  All those poor souls rotting away in "extended care" facilities are completely different than US!

Do you imagine there is anyone in a nursing home right now who wanted to go there?  Is there anyone decaying away there who imagined that was the way their life would turn out?

Let's get in our time machine and turn the clock back so we can interview some of the residents at Homily Euphemism Nursing Home: 

Now it's 1944:

Roger, 5 years old:  "When I grow up, I want to be a pilot and fly airplanes ZOOOOM!! and then be trapped lying in a nursing home bed pooping on myself!" 

Clyde, 16 years old:  "Yeah, well, I'm gonna apply at Stanford and, uh, you know, engineering and stuff, get it on with some babe and wind it up being fed mush by some distracted, overworked nurse's aide in a while a television blares banal daytime television nonstop in the background." 

Ethel, 24 years old:  "I want to marry Harley--he's got a job on the railroad!--buy a white house with a picket fence and have six babies named Ruby, Pearl, Sapphire, Jasmine, Hyacinth and Lavender and have them all secretly hope and pray that I die because they are emotionally exhausted from my raving dementia and they feel guilty about placing me in a nursing home."

The NIH says that 49% of our healthcare dollars are spent on 5% of the population.  That population consists mostly of the elderly. 

It seems very selfish to run up a huge medical bill on the way to your grave.  

I have been a nurse for nineteen years, and I have seen a lot.  Here is my advice, for what it's worth:

Do not put anyone over 80 on dialysis 

Do not put anyone over 80 through open heart surgery

Do not put a PEG tube in ANYONE.  Well, okay--if your father anally raped your children and sold the pictures online--then it would be okay to put a PEG tube in him.  That is the ONE AND ONLY exception!

Do not put a tracheostomy tube in ANYONE!!  Even if your father is Pol Pot, tell the doctors, "I know that my father is a sadistic war criminal who buried people alive under his policy of, 'Don't waste a bullet'--but really, I just can't bring myself to put a trach in anyone!"

Practice saying these words, "Let's just keep them comfortable." 

When the doctor says, "Do you want us to take them back to the cath lab?"  say, "Let's just keep them comfortable."

When the doctor says, "Well, we would need to start chemotherapy," say, "Let's just keep them comfortable."

Death is not the worst thing that can happen to you.  Death can be a merciful out.  Medicine is a very sharp double-edged sword. 

We can keep you alive.

 

How it all Started

In the beginning there was a BIG EXPLOSION!!

Well, it wasn't really a big explosion, since there was no space and no time, no one to hear it and nothing outside of it. 

Anyway, the universe was born!

Then the Earth cooled...

The Earth was pummelled with comets--

The comets brought water, which formed oceans.  The ocean and land separated.

Life began in the oceans...

Soon, the oceans were teaming with life...

Life in the ocean became very competitive.  Some creatures moved on to dry land.  Scientists think that the first animals to venture onto  land went there to escape predators...

But, I have a different theory...

Some animals moved to the land and adapted well, but then were not happy with their decision...

So, they returned to the water...

Some creatures tried to live on both land AND water...

One misty orange sunrise in the early Pre-Cambrian, the first nurse crawled out of the primordial gruel...

walked to the nearest hospital...

timed in...

and went to work.

and that's how it all began.

My Gremlin

Getting ready for work, after I pull my scrub top over my head, a gremlin climbs onto my shoulder and perches there, clutching his bullhorn.  He stays with me all day as I drive in to work, get report and start my shift. 

If a tense discussion starts with a doctor, patient, family member or fellow nurse, my gremlin pulls out his bullhorn and yells, "SHUT UP, CAMILLE!" into my ear. 

I ignore him more than I should.

How to Be a Good Parent in 3 Easy Steps

I hear people arguing all the time about what it takes to be a good parent.  It confuses me.  

Being a good parent is very easy.   So few people seem to understand that. 

The demand for this information is very great, so I will post it here.  I am calling it, "How to be a Good Parent in 3 Easy Steps". 

Catchy, huh?



 "How to be a Good Parent in 3 Easy Steps"





STEP ONE:

The doctor hands you a squalling baby

STEP TWO:

Fast forward eighteen years

STEP THREE:

Out of your front door walks a competent adult who has been taught how to think. 

That should be your primary goal.  Teaching your children HOW TO THINK. 

Old Chinese proverb, "Give a man a fish and you feed him for a day.  Teach him how to fish and you feed him for a lifetime." 

 

Nurse's Note:  Compare the picture of the newborn to the picture of the nurse--nurses barely metamorphose with maturity.  We are just born perfect! 

Our Gang Sign

I work in an inner city hospital in a bad part of town.  Nurses from bourgeois suburban hospitals areas frequently ask me, "Aren't you scared to walk into work?  Isn't it dangerous?"

I tell them, no, our nurses are so bad that every floor has its own gang sign.  Hospital administration hired Mr. 50 Cent to go floor to floor and teach the staff how to show their gang signs.  

We are on Unit 3-G.  This is what, "3-G" looks like from Mr. Cent:

This is what "3-G" looks like from us:

Scared yet?

Speaking in Code

I am going to tell you something shocking now.  Shocking and terrible but true.  Read this sitting down. 

Ready?  Do you have a glass of warm milk?  Tissues handy?  Your mommy’s phone number on speed dial? 

Okay, then, here it is:

You are going to die. 

Take some deep breaths.
 

It is shocking, I know.  You will die, I will die, everyone around us will die.  Everyone who has ever lived has died.  All the heroes and villains and mediocre folks in between are dead.  Genghis Khan, Edgar Allen Poe, Plutarch and Alexander Fleming, the guys who built the pyramids, Solzhenitsyn’s tutors and Cleopatra's wet nurse.  Dwight D. Eisenhower’s mother is dead.   And his father.  And his dog.

You get the picture.

                               "I feel poorly"

           

We are a species that denies death.  We need to in order to  carry on with our lives.  Our amazing brain allows us to predict the future (I’ll retire at 68 with full benefits and move to Tahiti), but it also makes us aware of our own demise. 

It is stressful. 

When we think about it, it overwhelms us.  It makes it difficult to engage in day-to-day activities.  So, we push it aside our whole lives.  Death is going to be something that will happen to us “later”.

But, "later" always becomes, "now" eventually. 

We all "know" that we are going to die, but we don't realize it. 

I see patients every day who need to have their code status addressed.  Translation:  they need to be made a NO CODE.

What is a code?  A code is when a bunch of people run in and start pumping on your chest, breaking your ribs, shoving a tube down your throat and pouring thousands of dollars of drugs into you.  If needed, they shock you with electricity.   It is brutal, horrific to watch and stressful to be a part of.

When polled in 2010, Americans said that they thought that the success rate of a code was 64%.  Actually, it is closer to 11%. 

The outcome of a code is directly correlated with the patient's age and previous medical conditions.  A twenty year old who falls into a swimming pool should be aggressively coded.  An eighty year old with metastatic cancer, should not.  It is pointless, costly and sadistic.

Death is the end of life.  That's it.  The reason that the patient has coded is because they are trying to die.  Even if the patient survives the code, they still have all of the diseases that caused the code in the first place. 

Nurse's Note:  a code does not cure cancer, heart disease, hepatitis, COPD or kidney failure

I often hear anxious family members--who have been brought up on a steady diet of television hospital drama--asking their doctor, "So, is there NO chance?"

Your doctor is a scientist.  His degree is not in haiku, pointillism or underwater basketweaving.  His degree is in science.  No scientist worth the salt on his french fries is going to say, "No, there is NO chance." 

There's a chance that my trash can might learn to skydive.  There's a chance that Neptune's climate is compatible with growing pink grapefruit.  There is a chance that people with triple-pierced ears won't get prostate cancer.

The chance might be 0.0000000000000000000000000000000000000000000000000001, but it is a chance.

Don't put yourself or your family member through a code.  Have the courage to realize that when the medical team brings this issue up, you are going to die, regardless of anything and everything we do.  You can choose to spend your last days imprisioned in the ICU going through procedures that you will think were invented by the Marquis de Sade, or you can be made comfortable surrounded by your family.

How do you want to spend the last days, hours, minutes of your life? 

Todd Akin goes to Hell

I don't know if you heard this on the news, but Todd Akin died last night.  Todd Akin was a Republican United States Representative from Missouri who said that in, "a legitimate rape the female body has ways to shut that whole thing down" and therefore cannot become pregnant.

 

I don't know what Mr. Akin studied in school--or IF he went to school--but I am sure it wasn't gynecology.  The human female has no such capability.  To say that it does is like saying the earth is flat.

Anyway, so now Mr. Akin is dead.  Expecting to go straight to Heaven as a Christian fundamentalist, he was surprised to instead be ushered through an unusual gate...

He sat in the waiting room for several eons, waiting to be judged.  The waiting room was filled with that modern art stuff that he hates...

The walls had signs with the repercussions for demeaning women.  Farmer Brown and Santa Claus both paused by one that listed the punishments for calling women "hoes".

 

Todd Akin waited 11.72 eternities in the waiting room before he finally got his chance to explain all the stupid stuff he had said about women.  He walked right in and saw his judge...

Nurse's Note:  If you don't have a car--and have NEVER driven one--don't try to teach me how to drive.  You sound like an idiot.  

(c) copyright 2012 by the author of this blog.  All rights reserved.

Rat Poison

Let's talk about Atrial Fibrillation. 

I don't work for a pharmaceutical company, but I am a big fan of warfarin sodium, the drug commonly referred to as, "Coumadin".

Coumadin is frequently prescribed for a condition called,  "atrial fibrillation".  For all you non-medical folks out there, atrial fibrillation--afib--is a disease where the electrical impulses controlling the upper chambers of the heart are erratic.  As a result, the heart's upper chambers--the atria--quiver ineffectively.   Blood isn't pumped well; clots form in the heart.  These clots can break loose and be ejected into the body.

All blood pumped from the heart goes into the aorta.  The aorta is like a SUPERHIGHWAY from the heart; every other artery branches off of it.  

Aortic Superhighway

There are two little arteries immediately off the aorta that feed the heart itself, like back roads that only the maintenance workers can use. 

The next TWO arteries branching off of the aorta go to the brain.  That is where clots being shot out of your heart by its own pumping action are most likely to go.  Your brain.

A clot that travels to your brain and clogs an artery shut there is called a, "stroke".


For those of you who need numbers to be convinced, some statistics:

Afib makes you 6 times more likely to have a stroke.

35% of people with afib will suffer a stroke unless treated.

Afib is responsible for 25% of all strokes

Afib strokes are more major and disabling

23%  afib strokes die (compared with 8% of other stroke etiologies)

44% suffer significant neurologic damage

Strokes in women are more disabling than strokes in men

Coumadin reduces the risk by 60-70%

My sister-in-law has been diagnosed with atrial fibrillation. She is refusing to take coumadin.

Her physician had her sign a waiver saying she understands the risks of not taking coumadin and she is releasing him from all liability.

Nurse's Note: If your physician asks you sign a waiver saying you won't sue him if a bad outcome occurs because you won't take a medication he's prescribed--RIGHT THEN a pulsing neon light and a 57,800 decibel siren should go off in your head. The Solid Gold Dancers should bust out dancing in your living room. 

Take a few minutes and re-think your actions.

Are there risks in taking Coumadin?  Sure!

Are there risks in driving a car?  In cooking spaghetti?   In petting Whimsy?

Every drug carries a risk.  That is what that encyclopedic-length disclaimer inside drug packages are all about.   But, it is a calculated risk.   The risk-to-benefit ratio has been carefully weighed.

Here's a test to see if you should take coumadin if your physician prescribes it.  Rate on a scale of 1 to 5 how valuable these skills are:

1=I hate that!
5=Gotta have it!

Your ability to:

1.  Feed yourself

2.  Get your pants on

3.  Wipe your own ass

4.  Walk to your mailbox

5.  Recognize your family (who IS that ugly old woman?)

6.  Live independently

7.  See

8.  Hear

9.  Bathe yourself

10.  Speak intelligibly 

If your test score was more than 0.3, take the drug your doctor prescribes.

If not--would you consider leaving me your car in your will?

(c) copyright 2012 by the author of this blog. All rights reserved.

PTSD

Nurses see tragic stuff.  The kind of tragedy that makes MacBeth look like Little Red Riding Hood.  Hospitals are the ultimate theater for human drama.

Sometimes I have a patient who tells me that they were in Vietnam, so they have PTSD.

I want to tell them, “Hey, I’m a nurse.  ALL nurses have PTSD!  Our PTSD is worse than your PTSD!”

Ethics, patient confidentiality and HIPPA keep nurses in a perpetual “vow of silence”.  This exacerbates our PTSD. Venting helps, but we aren't supposed to do it. 

HIPPA exacerbates my PTSD.

(c) copyright 2012 by the author of this blog. All rights reserved.

The Land of Addictia

Nurses have ambivalent relationships with narcotics and benzodiazepines.  Those drugs have an important role in health care.  Pain and anxiety are formidable opponents.


Drugs can be good; drugs can be our friend!  


But, there is a DARKER side to drugs

 DUM-DUM-DUM!!  



Drugs can take your humanity and make you into a self-centered husk.


Here are some of my favorite addicts with their scepters:

Cocaine

   

Patients with cocaine troubles are usually upper class.  They arrive in a Porsche wearing an Armani suit or clutching a Coco Chanel purse.  Their hair is professionally styled.  They have chest pain and tachycardia; their blood pressure is stroke-high.  

When you explain that you need a urine sample, they glare at you and say, "Do you know who I am?"

Doctors frequently come up in conversation.  "Dr. HeadHoncho golfs at my country club.   My pool boy used to work for Dr. BigCheese.  Dr. NumeroUno is my next-door neighbor."

Nurse's Note:  The doctor is not my boss.  He's just another  coworker.  Stop threatening me.

Meth

Meth is bad.  Meth lab explosions cause children to be brought in to the emergency room with third degree burns and carbon monoxide poisoning.   Meth addicts have broken black teeth and jittery, manipulative behaviour.  They don't sleep, they are tachycardic and it is difficult to bring them down with anxiolytics.  Their skin is covered with sores they've dug to get those burrowing bugs out.

Meth is bad. 

Heroin

Heroin addicts come in with endocarditis and hepatitis C.  Their high tolerance to opiods makes it nearly impossible to treat them for pain.  If they need surgery, ordinary dosing does not touch them.  And since they almost always deny their addiction,  you usually don't discover it until they are withdrawing and you have had to tie them down with four-point restraints.

Marijuana

Marijuana just doesn't seem that bad to me.  In all my years as a nurse, I have never seen a patient come in with a marijuana overdose, marijuana poisoning, marijuana seizures or any other issue specifically related to marijuana.  

But, I have seen a lot--and I do mean A LOT--of alcohol overdoses and alcoholic liver failure.  And a lot of respiratory failure, small cell lung cancer and COPD from cigarette smoking.

Why have we demonized marijuana and legalized cigarettes and alcohol?  Are the pot smokers holding up the local grocery store for chips and pizza to ward off the munchies?

America has a schizophrenic attitude about drugs.   I've heard the argument that marijuana is a "gateway drug" to harder substances.  That folks using meth, heroin and cocaine started with marijuana.

Bullshit.

The folks using meth, heroin and cocaine started with cigarettes and alcohol.

 What causes the most damage to humans, illegal drug use or cigarettes?  It's cigarettes.  Cigarettes are worse than all the illegal drugs COMBINED. 

 

 Let's stop throwing flower children into prison and start growing and taxing pot.  Our national deficit would vanish in five years.   It would create jobs, employ farmers and get the criminal element out of it. 

Haven't you seen, Breaking Bad?


Nurse's Note:  I have actually GIVEN marijuana to patients, including pediatric patients.  It comes right up from pharmacy in a neat little capsule labeled, "marinol".   It is prescribed to increase appetite and prevent nausea. 



(c) copyright 2012 by the author of this blog. All rights reserved.