Evil Vaccines

When a patient is admitted to the hospital, a nurse has to fill out an admission profile.  The profile consists of about 1,093 questions.   "Are you sexually active?  With men, women or both?  Do you use a condom?" 

These queries sometimes become awkward when the patient is a deaf old lady with periwinkle hair.  "DO YOU PRACTICE ANAL INTERCOURSE?!?"

A visiting doctor from Ethiopia looks up from the desk.

There's a section in the profile on vaccinations. "Is patient current on vaccinations?  Does patient want influenza/pneumoccocal vaccine this hospital stay?"

I'm tempted to paraphrase this question:  "Hey, do you want our most recent version of the medical miracle that has saved millions of human lives?  Are you a history buff?  Smallpox wiped out one-third of the exposed population!  I'm not shittin' you!  Whatcha think?"

This should come as a shocker to anyone who has not been lobotomized, but patients often reply, "No!  Vaccines cause autism in our vulnerable children!  My neighbor Sunlight DoNutHole never had a vaccination in her life!  She is 68, smokes pot every day and feels just fine!  Take it awaaaaaaaaaaaay!  Take it awaaaaaaaaaaaay!!"

I never argue.  This is a battle I'm not gonna win.  The public is super-saturated with celebrities on talk shows sobbing about how their precious child was damaged by an evil vaccine.  They need to blame SOMETHING.   

And the public listens.  We are attracted to attractive people.  Blonde actors with capped teeth and trained voices have plenty of credibility.  It's tough for some geeky-looking scientist to come on TV and compete with a professional entertainer.  But, does Jenny McCarthy really know more about immunology than the doctors at NIH, Stanford, Vanderbilt, Johns Hopkins and the Mayo Clinic? 


So, who ya gonna believe?

Or...

The odds of changing people's minds are poor when there is such a huge emotional investment.  To convince them, I would have to confront their fear and guilt.  What if they become angry?  What if they complain to my nurse manager?   

Besides, I can hear call lights going off, I need to draw a PTT in ten minutes and that art line waveform looks dampened...

So, I just smile and click on, "Patient Declined" and move right on to the next screen.

The world is overpopulated.  You don't want our vaccines?  Are the bad nurses threatening you with needles?

This is natural selection at work.

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)

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.

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.

Compliance

Modern medical science has given us longer, better lives.  Hospitals are full of magical contraptions--Xrays and CT scans and lasers and radioactive sugar and giant magnets.    Capsules, tablets and IV drugs flow like a pharmaceutical river; oxygen and nitrous swirl in a gaseous vapor.

The magic of health care is expensive, though.   In 2011, the United States spent 2.5 trillion dollars on health care.

(I don't think all that went to the nurses.  At least, it didn't go to me.)

And pain--hospitals are full of pain.  Drawing blood, starting IV's, cutting off limbs, sawing open chests, drilling into skulls. 

Lots of pain.

But, the pain and the exorbitant cost are worth it, because this is your life we are talking about.  It's your LIFE.  Right?  

That's what I thought.  But, I see people everyday who come to the hospital and then won't help themselves get better.

They act like I am the enemy.  They call me names.  A few of which are actually true. 

The way that my mother might have made a living has been brought to my attention.  I have been told that my parents were not actually married.  It has been suggested that I am in the wrong taxonomic class.

Nurse's Note:  I don't actually know what my mother did for a living.  She SAID she was an air traffic controller, but she might have been lying!  If she really was a prostitute, she sure dressed badly for that job.  

Another Nurse's Note:  I don't know for sure that my parents were married.  I wasn't invited to the ceremony.

Patients have come in fluid overloaded, struggling to breathe, eyes popping, rhonchi audible from the parking lot,  blister-covered feet like rising purple dough--and then they argue endlessly with you about how they want more water. 

All of my reasonable explanations are met with anger and denial.  I am a hateful bitch.  I don't know what I am talking about. 

I catch them drinking out of the sink.  I turn the water to the sink off.

I catch them drinking out of the toilet.


Sometimes, patients try to turn their health care into a power struggle.  "I'm not taking that pill unless you bring me another ice cream!"

"I'm not gonna be your guinea pig!"

I really want to say, "Great!  Works for me!"  and walk out.  

Instead, I have to say (in as reasonable of a voice as I can muster) "Of course, you don't have to take any medication that you don't want.  You are not a prisoner here.  My job is to educate you and to tell you what we are doing and why.  If you don't want to do it, we won't to make you."

Arguments go something like this:

"You can't make me stay in this bed!" 

But--you have a balloon pump in your femoral artery...

"I'm tired of this blood pressure cuff!  I'm not wearing it!"

But--we are titrating norepinephrine to sustain your blood pressure...

"I want my mother in here RIGHT NOW!!"

But--we are in the middle of a sterile procedure...

"I'm not wearing those leg things!! They make me hot and keep me awake!"

Uhhh...blood clots...stroke...pulmonary embolism...

Don't come to the hospital and then refuse to do what the medical team recommends.  Would you take your car to a mechanic, ask their advice, pay for it, and then refuse to do it?

We are all adults here.  If you are unhappy, leave.  

If you choose to stay, then work with us to improve your health.  We'll all be happier.

Nurse's Note:  Nurses are paid the same regardless of their patient's compliance with medications, blood draws or tests.  After twelve hours, the nurse walks out the door, whistling a jaunty tune, her car keys jingling. 

The sky is a wash of crystal blue. 

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

Kiddie, Kiddie

Most hospitals have an age limit for visiting children.  When this is explained to some parents, they act like I am a serial killer who despises children.   

I do hate children--but that is not the reason they shouldn't be visiting the hospital.

Before I became a nurse, I thought hospitals were very clean places.  Everyone wore white and operations were done there, so they were all sterile.  Right?  

About 3.7 seconds into my first shift I changed that thought process forever.  Hospitals house patients brought in by land and air with every sort of infection on the planet.   The worst illnesses have been concentrated into one building.   Vomit, diarrhea and pee flood the floor regularly.   Blood splatters, wounds weep.  Pus-filled dressings fall, shitty sheets drop, blisters ooze. 

These body fluids are vectors for the most dangerous organisms.  Humans have been waging war against microorganisms for many years now, and the little creatures have fought back by becoming resistant to many of the drugs we use on them.  Hospitals are basically petrie dishes of powerful disease.    

  

Even if you are sure that blood and poop have not hit the floor in YOUR room, think of this:  the nurse, dietitian, respiratory therapist, doctor, social worker, clerk and every other staff member who comes in your room has been in other rooms.  Imagine what is on the soles of their shoes, tracked up and down the hall, in and out of the rooms. 

I see visitors walking up and down the hall in their bare feet all the time.  Many nurses won't wear their nursing shoes home.  That's how contaminated the floor is. 

I see people sitting on the floor with burritos and popcorn and milkshakes spread around like a picnic.

I see infants crawling on the floor, then sitting up and putting their little hands in their mouths.  

Nurse's Note:   Do not bring small children to the hospital. 

Nurse's Note:  Wear shoes!

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

To visit or not to visit? That is the question...

Visitors arouse conflict in a nurse’s heart.  A good visitor is worth their weight in Xanax.  A bad visitor makes the nurse wonder why she didn’t take a job hanging off the back of a garbage truck (plenty of fresh air and all you can eat). 

A good visitor is comforting and supportive of the patient, but ALWAYS ON THE NURSE’S SIDE.  That's worth repeating:  A GOOD VISITOR IS ALWAYS ON THE NURSE’S SIDE.  The reason for this is simple—the nurse is already on the patient’s side.  Siding with the nurse IS siding with the patient. 

A good visitor is encouraging and cheerful. 
 They are a calming influence in the face of unknown outcomes and a distraction from the boredom of a hospital room.  A good visitor encourages the patient to be brave and compliant with the treatment plan.

A good visitor does NOT encourage the idea that their famiy member's nurse is the reincarnation of Nurse Ratchett.

A good visitor respects the rules. 

If the unit has restricted visitation, don’t bring eleven people into the room then demand sandwiches, coffee, sherbert, extra chairs, pillows and blankets.  This is a sick room, not a slumber party. 

Pillows and blankets--and everything else--are in limited supply.   If your room has ten chairs in it, then there are nine other rooms with no chairs in them.  

If an emergency happens and there are eight people camped out on the floor, the medical staff can’t get the code cart to the bedside.  I've tripped over sleeping family members when trying to get to a patient in Vtach.

Nurse's Note: Go to Yosemite to camp.

To ensure patient privacy, visitors should not be wandering up and down the halls, leaning over the nurses's shoulders--all ears--asking for a pen, peering at the charts and computer screens. 

In all sorts of questionable dress.

About the ice water:  I don’t mind getting visitors ice water.  But, some visitors seem to have taken a wrong turn on their way to Red Lobster.  They want food, they want soda, they want ice cream. 

Food trays are sent up for the patients from the kitchen.  The food supply available on the floor is limited to juice and jello. 

Also, the food is for the patients.  

Nurse's note:  Your dad's nurse is not your waitress. 

Visitors need to feed themselves.

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