The Name Game

The nurses in Labor and Delivery should be paid extra for keeping a straight face when they hear some of the names given to babies.   I've met babies named, "Knives", "Rumor" and, "Murder".  I'm still waiting for "Spoon", "Gossip" and "Manslaughter".

I also see names spelled in all kinds of strange ways.  Many Americans think if there is an accent mark, an umlaut or a circumflex thrown in randomly it proves they are erudite and cosmopolitan.

So, here's a combination of names that aren't really names AND creative spelling!

Can you read these names?

*Toenail, Carpet, Stripes, Leather Jacket, Fungus

The Doctor's Paw

The Monkey's Paw is a short story by W. W. Jacobs about a gruesome talisman that grants three wishes.  The moral to the story is, "Those who interfere with fate do so to their sorrow". 

Modern medicine has a lot of parallels with The Monkey's Paw.  All the elements are there:  meddling with natural order, unreasonable expectations and horrific consequences. 

Here's my medical version of The Monkey's Paw.  I'm calling it, The Doctor's Paw. 



Once upon a time, there was a man named, "Ernest".  He lived in a typical house in a typical town in a typical state.  He worked hard as a fireman, saving people and property.

Ernest married a wonderful woman and they had two adorable children.  He had a great life!

But Ernest grew older.

One day, Ernest couldn't get his breath.  Faint and gasping, he went to the hospital.

In the hospital, he met Dr. Duno Goode.

Dr. Goode told Ernest about a charmed amulet--the Doctor's Paw.  Dr. Goode explained that The Doctor's Paw could grant three wishes.  But the wishes would come true at a terrible price.

 Ernest was too scared to understand that.  He couldn't breathe!  He grabbed for the Doctor's Paw and made his first wish-- he wished that his breathing would be made easier.

He was placed on bipap at 15/8 with 100% bleed-in.  To provide nutrition, a stiff plastic nasogastric tube was poked down his nose into his stomach.  Sticky, smelly liquid was pumped into it.

 

Now, Ernest was very uncomfortable.  The bipap's strong air pressure felt like his head was hanging out of a space shuttle on its way to Jupiter.  The feeding tube down his nose made him gag constantly.

Once again, Ernest reached for the Doctor's Paw.

"I want this mask off my face and this tube out of my nose!"

Dr. Goode cut a tracheostomy into his throat.  A PEG tube was crammed into a hole sliced into Ernest's abdomen and stomach.

"I don't want to live like this!" he wrote in a shaky hand (he could no longer speak with the tracheostomy).  "Let me die!"

It was his last wish.

His code status was changed to "DNAR".   The hospital shipped him off to a nursing home where he lived for eleven years lying in bed on a ventilator, wearing a diaper, being turned every two hours and fed through a tube in his stomach.

The End

 

 

Nurse's Note:  evaluate your code status carefully

Public Service Announcement

Some countries have mandatory public service requirements like serving in the military or working with underprivileged children to graduate from high school or college.  Those are great ideas, but I'm gonna add one more:  countries should require every person to work in a nursing home for six months. 

 Let's educate our young citizens to know what they do and do not want from health care.

Restrain Me

Restraints are increasingly unpopular and politically incorrect.  There's a big nationwide push get rid of restraints in hospitals.

But, nurses don't tie down little old ladies for thrills.  For one thing, it's a lot of documentation--restraints have to be charted on by the nurse every two hours and reordered by the physician every 24 hours.  Patients don't like being restrained and the family members are stressed to see their loved one tied down.  

So, why do nurses do this legally risky, unpopular thing?  The most common reason restraints are used is that the patient is on a ventilator.  The ventilator is a breathing machine that is SAVING THE PATIENT'S LIFE EVERY MINUTE. 

 

Every minute.

 

Imagine having a tube the size of your little finger shoved all the way down your throat.  It makes you gag; you feel like you're choking; you can't talk.  Your immediate impulse is to pull the damned thing out.   That's why ventilated patients are restrained.  We're not punishing them.  We're keeping them safe.

I have heard of hospitals that don't restrain or sedate ventilated patients.  Frankly, I just don't believe that.  Unless every one of their intubated patients has a sitter or is chemically or physically paralyzed they are going to self-extubate.  It's a normal response when something obstructs your airway to want to remove it. 

If a patient pulls out their breathing tube they can die.  We would have FAILED to keep the patient safe.  

What will you say to the judge?  (Because the wrongful death lawsuit WILL go to a judge)  

 

"I didn't restrain them because of the political climate"?