Potty Posture

I told a nurse recently that I suspect another co-worker has Asperger's.  To prove my case, I counted off:  poor eye contact, dislike of being touched, intense focus on one subject, inability to bond emotionally and strange body posture." 

She looked at me oddly.  

I insisted,  "Yes! 'Strange body posture' is a common symptom of Asperger's."

She let out a breath and laughed.  "I thought you said, 'strange POTTY posture'.   And I was trying to imagine what 'strange potty posture' might be, and how you might know about his potty posture..."

That started me thinking...

And here, as a result, are my top 5 Strange Potty Postures:

Aim High

Toilet Torque

Back in the Saddle

Open Fly Handspring

Standing Bridge with Waterfall

Whalese

At dinner my daughter told me that she had listened to whale sounds in school. 

 

I told her that I speak Whale.  Not all Whale, of course, but some of the more common dialects.

 

She looked skeptical.  "Really?"

 

"Oooooooooooooooooooooooooooooeeeeoooooooooooooooooeeee," I said.  "That's Blue Whale.  Now, Humpback Whale is completely different.  In Humpback, it would be, 'Iiiiiiiooooooooooooooiiiiiiioooooooooooooooooouuuuuuuiiiiuuuuu'.  Beluga Whale is a tonal language.  To say it in Beluga, it would sound like, 'Eeeeeeeiiiiiiiiiiiiiiiiiiiiiiiiiieeeeeeeeeeeeeeeeee'.  And, the Minke Whale--well, my Minke is poor, but I think it is, 'Eeeeeeeeeeeeeeeeeeeoooooooooooooeeeeooooooooooeeeoooooooo'."

 

She was trying not to laugh.  "What is that supposed to mean?"  she asked.

"It means, 'Ellen, clean the kitchen'." 



I'm a creative tyrant.

The Most Important Decision

Have you ever listened to someone trying to explain a complex theory--like nuclear physics or aeronautical engineering--and even though you are trying very hard to focus and pay attention, you really don't understand a damned word of it?  Despite your best efforts to grasp the concepts, you just don't have the education or the background to "get" it. 

I think that is what lay people feel like when a doctor tries explaining their loved one's illness and prognosis.  They are tired, scared and confused.  They don't understand what is going on.  They have a terrible hope mixed with a terrible fear.  And they have been raised on a steady diet of television where all health-related issues can be wrapped up neatly in 60 minutes minus commercials. 

Here's what I think:  Doctors should not be allowed to offer expensive, futile, sadistically cruel options to patients or their families.  The doctor is the educated expert; they need to act like one.  The doctor should have the right and the responsibility to say, "Your mom is going to die.  We will keep her comfortable."

That's it.

Too many families are unable to make a reasonable decision when overwhelmed with all this strange, threatening information (cerebral vascular accident, myocardial infarction, pulmonary embolism, septic shock).  Emotions are coming in tidal waves at such a time.  When offered an option, like, "We could trach her..." scared people are going to leap at that chance.

Isn't a "good" person supposed to fight to have their mother live? 

Do you officially become a BAD person if you agree to let her die?

Will you have to wear a placard?

It is an uninformed decision from a lay person.  Ask an ICU nurse if they would want a trach or a PEG tube.  Ask a cardiologist if they want to be coded.  

Requiring the families to make these types of decisions is unrealistic and unfair.  The doctor is the expert.  The doctor should not offer false hope by prolonging the inevitable.  You don't fix the brakes on a car that has been totalled.

How do we make decisions about other serious matters?  In other areas where people's lives and freedoms are at stake? 

We have a system in place that does just that: it's called the justice system.  This is another area rampant with conflict, emotion, massive expense, human suffering and a strong desire to do the "right" thing. 

So, we bring in twelve people.  They hear both sides of the argument, pro and con.  They weigh the evidence.  Then, they vote.

Does the victim get a vote?  No.

Does the victim's family get a vote?  No.

They can be heard, but they don't get to vote. The victim and the family are too enmeshed to be able to make an objective decision.  Everyone understands that allowing them a vote wouldn't be justice.

Is it a perfect system?   Uhhh--no.

Is it the best anyone has ever come up with?   Absolutely yes!

Nurse's Note:  Anybody out there who has a better idea just come right on up and tell us all what it is.   I--for one--would love to hear it.  

That's how our health care system should handle end of life issues.  It would take the burden off the families and give it to an educated, experienced group of doctors, ethicists and nurses. They could review the case, go over all the data and visit the patient and the family.   Then, they would vote on the best hospital course.


Who do you want making decisions about what should be done to you medically?  This group:

Or this one?

Could they be wrong?  Sure!  Anyone can be wrong.  Juries don't make decisions about people's lives based on evidence that is beyond all doubt.  Juries make decisions about people's lives based on evidence that is beyond REASONABLE DOUBT.  "Beyond all doubt" is too impossible of a standard.

Nurse's Note:  Ignore inflammatory comments about death panels.  We don't call juries, "death panels" even though they are making decisions about human lives.  That kind of provocative rhetoric is calculated to foment fear.

As a matter of fact--ignore anything that ever came out of Sarah Palin's mouth.

People say that I'm judgemental.  It's true; I am.  Everyone is.  And everyone needs to be.

Do I have time to get across the street before that oncoming garbage truck runs me down?  It's a judgement call.

Should I wear my purple socks with this mustard and mint-striped halter top?  It's a judgement call.

Should I go on out on a date with a guy who has both eyelids pierced with rusty six penny nails and a skinned kitten hanging from his rearview mirror?   Judgment is REALLY needed here...

It always strikes me as a silly, specious argument when people say, "Who are you to judge?" 

Who am I?  I'll tell you:  I'm a wife, a mother, a daughter, a sister.  I'm a human being stumbling around on this planet sucking in oxygen.  I'm a taxpayer and a citizen.  I'm also a nurse with plenty of first-hand experience.

Saying, "It's not up to me to judge," is like covering your eyes while your house burns down around you. 

Imagine your dog became too ill to eat or breathe adequately.  If you said, "Oh! I just CAN'T let Fifi die!" and had a trach and a PEG tube put in Fifi and put Fifi in bed where she lay in her own excrement, getting bedsores that ooze pus--your neighbors would call the Humane Society.  

You wouldn't treat a dog that way.

What do we remember?  We remember the beginning and the end.  Writers and directors know this well.  When filming a movie, you want a powerful opening scene to grab the audience's attention.  There can be some slow, saggy parts midway, but the end has to be fireworks-phenomenal.  Because when people think about it later, that's what they'll remember.  The beginning and the end.

Do you remember when you met your spouse?  Most people do.

Do you remember the divorce that ended it?  I'll bet you do.

Don't have the life of someone you love end in a nursing home.   Keep your memories sacred, not polluted by the thought that grandpa died comatose or so demented that he was masturbating to pictures of his grandchildren. 

My family knows never to code me and never to put a trach or a PEG tube in me. 

Ever.

Ever.

If they do, they better HOPE I don't get up from that bed.

Movie Script

Scene:  Late night in a large urban center.  The camera zooms in on Our Hero, Derek, RN, driving a black truck down a silent suburban street. The Dixie Chicks are playing loudly, causing the truck's windows to vibrate. Close up of Our Hero singing along with the divas.

Flashing red and blue lights illuminate the interior of the truck, a police siren sounds. Our Hero pulls over.

Police Officer #1 is a stoutish man with a mustache the color and shape of a hedgehog. He approaches the truck with a flashlight held over his head interrogator-style. Derek rolls his window down, trying to appear cooperative. He debates what his facial expression should be. Should he smile? Or act annoyed?

Police Officer #1:  Do you know why I pulled you over?

Our Hero Derek, RN:  (on to their game--they are fishing, never volunteer anything like, "Uhhh, the body in my trunk?") No, I really don't.

Police officer #1:  (shining his flashlight into the interior of the vehicle) You have a tail light out.

Our Hero Derek, RN:  (relieved) Oh. I didn't--

Police officer #1:  (continuing to play the light around the truck's interior) Are you aware that it is illegal to operate a motor vehicle without the proper safety equipment?

Our Hero Derek, RN:  Well, yes, but--

Police Officer #1:  (his light falls on drawings partially concealed in the passenger seat) What's that?

Our Hero Derek, RN:  What?

Police Officer #1:  That! Right there!

Our Hero Derek, RN:  (jumps slightly, looks) Uhh--

Police Officer #1:  Don't act like you don't see it! Don't try to con me!

Our Hero Derek, RN:  (playing for time, thinking, "shitshitshitshitshitshitshit") Oh, this?

Police Officer #1:  (abruptly drawing his .45 caliber slide action stainless steel handgun that substitutes for a penis and pointing it directly at Our Hero Derek's face) Freeze! Freeze!

Our Hero Derek, RN:  Uhhh--

Police Officer #1:  Get your hands where I can see them!

Our Hero Derek, RN:  (cautiously placing both hands on the steering wheel) Officer--

Police Officer #1:  I'm on to you! I'm on to you! Get 'em up!

Our Hero Derek, RN:  (raising both hands in the air, nervous about having the muzzle of a gun shaking wildly three inches from his face)  I think--

Police Officer #1:  (activates his radio with one hand, his eyes never leaving the perpetrator) Station, station 1-9, I have a 4-9-2-6 in progress, repeat 4-9-9-6, suspect held at 7-5-2-4-6-1-1, I am 9-2-2-6-4, requesting immediate backup, 2-5-5-9-7-1-6, over.

Radio makes crackling noises, we hear a woman's voice (she is obviously chewing gum):  Roger that, 7-2-3-3. Backup on the way, over.

Our Hero Derek, RN:  Sir--

Police Officer #1:  (screaming now) I said freeze! Keep your hands where I can see them!

Helicopters are heard loudly approaching overhead. Jeeps, tanks and humvees come roaring onto the scene, knocking over mailboxes and swingsets. Doors are kicked open.  Rangers, National Guardsmen and Navy Seals swarm out. The 101st Airborne Division parachutes down. Uniformed troops go running everywhichaway, securing the perimeter, their M-16's drawn Elian Gonzalez-style.

Their captain leaps into view, his muscled legs in wide stance, blonde hair blowing dramatically. As soon as he comes on camera, his shirt is caught on a tree limb and ripped off, leaving him naked from the waist up. The camera pans sloooooooowly up from his shiny boots, lingering on his bulging crotch, his muscled chest and his glinting blue eyes. The Captain is gripping a light anti-tank weapon.

Captain:  (smashing two trash cans out of his way to clear a path) Out of the car! Get out of the car!

Our Hero Derek, RN's neighbors are waking up and coming outside to see what all the commotion is about, rubbing their eyes sleepily.

Our Hero Derek, RN:  (shell shocked) Uhhh--

Captain:  I said GET OUT OF THE CAR!! NOW!!! NOW!!!

Our Hero Derek, RN:  (groping for the door handle) Okay, okay--

Police Officer #2:  (drives up recklessly on a motorcycle, nearly running over an anorexic woman in a thong. He vaults off the motorcycle, gun drawn. He is a Hispanic male with high, chiseled cheekbones) Ay-Yi-Yi!  You! You een zee truck! Keep your hands ver vee can zee zem!

Police Officer #1:  Get 'em up! Get 'em up!

Our Hero Derek, RN:  (freezes, confused) Uhhh--

Captain:  I said, GET OUT OF THE VEHICLE, ASSHOLE!!

Police Officer #3:  (runs up wearing a gas mask, his voice is muffled by the filters) KEEP YOUR HANDS--

Police Officer #1: UP! UP!

Our Hero Derek, RN:  Do you want me to open the door or keep my hands up? Or crawl out of the window?

Police Officer #4:  (swaggers on camera, he is 6'6' and weighs about 230) A wiseguy, huh? (he rips the door off the truck and throws it aside. It narrowly misses decapitating a skinny kid in a leather jacket.)

A little girl in footed pajamas ventures closer, sucking her thumb. She is clutching a stuffed purple rabbit.

Our Hero Derek, RN hesitates.  Police Officer #4 grabs him by his scruff and throws him out of the vehicle. Our Hero Derek is slammed onto the cold concrete. Police Officer #4 jams a knee in Our Hero Derek's back and handcuffs him.

The crowd presses closer. Two local television crews arrive, along with ABC, NBC, CBS, CNN, the Weather Channel and Animal Planet.

Detective Lieutenant Sergeant:  (saunters onstage, he looks like Jon Hamm in a trench coat) Well, well, well. What do we have here?

Police Officer #1:  Look in his truck! You won't believe it!

Detective Lieutenant Sergeant:  (gesturing towards the cab of the truck) Search it.

Our Hero Derek, RN,  his mouth smashed into the concrete, mumbles something that sounds like, "search warrant", but everyone ignores him. Thirty-two helicopters are circling overhead, their searchlights glaring across everyone below.  News anchors are facing their respective cameramen and talking importantly. Makeup crews and hairstylists stand by.

Police Officer #3:  (fishing around inside the truck) My God! (he holds up the drawings like a trophy)

An old lady faints dead away.

Police Officer #4:  What is the world coming to?

Police Officer #1:  You sick bastard.

Captain:  You need serious help.

Police Officer #2: (handing Detective Lieutenant Sergeant the drawings) Here you are, zir.

Detective Lieutenant Sergeant: (casually looking through them) Well, well...

Police Officer #2:  We've got you now, you pervert!

A chubby Hispanic boy pushes closer, craning his head to get a better look.

Police Officer #4:  Hey, didn't we have this guy on John TV last week?

An audible gasp is heard from the assembled crowd, mothers pull their children protectively closer.

Police Officer #3:  (nudges Our Hero Derek, RN with the toe of his combat boot) Hey, wiseguy! Were you that guy on John TV that we busted last week?

Our Hero Derek:  Wha--

Police Officer #1:  It's him. I'm sure of it.

Police Officer #3:  (gestures to the drawings) This proves it!

Captain:  Look at that shit!

Police Officer #2:  Now I've zeen everyzing!

Police Officer #4:  What a world!

Police Officer #1:  I swear.

Detective Lieutenant Sergeant: (shakes his head ruefully, then adopts a, "you can confide in me" tone) Well, bucko, you're busted. There's no way out. You may as well talk.

Our Hero Derek, RN: But--

Police Officer #3:  Shut your hole when Detective Lieutenant Sergeant is talking to you!

Detective Lieutenant Sergeant:  How do you explain this? (thrusts the drawings down close to Our Hero Derek, RN's face)

Our Hero Derek, RN:  Officer--

Police Officer #4:  Well, asshole? What do you have to say?

Our Hero Derek, RN:  I--

Police Officer #3:  Yeah, how're you gonna talk your way out of this?

Our Hero Derek, RN:  It's--

Police Officer #2:  Are you gonna talk?

Our Hero Derek, RN:  There was--

Police Officer #4:  I'll bet he just lawyers-up.

Our Hero Derek, RN:  When--

Police Officer #2:  Zat's bullsheet.

Our Hero Derek, RN:  What I--

Police Officer #1:  Let's beat it out of him.

Our Hero Derek, RN:  Where the--

Police Officer #3:  Yeah!

Our Hero Derek,RN:  Guys--

Police Officers #5, #6, #7, #8 and #9 come running onto the scene carrying a taser, a hockey stick, an enema bag, a riding crop, 2" nails, a jackhammer and a tub of jello.

Detective Lieutenant Sergeant:  (kneeling down) Last chance, son. One way or another, you are gonna talk.

Our Hero Derek, RN:  (rapidly, desperately) I work with this nurse--

Police Officer #1:  Right.

Police Officer #3:  I'll bet.

Police Officer #2:  Just hit him.

Police Officer #4:  Can we use the saw?

Our Hero Derek, RN:  She likes to draw--

Detective Lieutenant Sergeant:  (listening intently, holds his hand up for silence. All talk, screeching tires, sirens and rotating helicopter blades abruptly fall silent) What?

Our Hero Derek, RN:  She draws these pictures...

Police Officer #4:  Is her name Camille?

Police Officer #2:  Camille Smith?

Our Hero Derek, RN:  (thinking he has misunderstood) Huh?

Police Officer #3:  It IS Camille!

Police Officer #1:  (looking closer at the drawings, passing them around) Oh, yeah!

Police Officer #7:  That's right! That is Camille's work!

Police Officer #6:  Did you see the, "Camille Goes to Hell" painting?

Police Officer #1:  That was amazing!  Truly groundbreaking!

Detective Lieutenant Sergeant:  I like her early work best.

Police Officer #9:  The post-modern stuff?

Police Officer #8:  I think I would describe it more as, "surrealism".

Police Officer #7:  It's not surrealism if it was done before Monet.

Police Officer #5:  Oh, yeah? What about Picasso?

Police Officer #3:  Yeah, what about him?

Captain:  I think that Picasso is officially considered an Impressionist.

Old black lady with frizzy white hair:  I have prints of all of Camille's blue period.

Little girl with the stuffed rabbit:  I like her purple period better.

Woman with hard black hair, pierced lip and neck tattoo:  Her cubism is amazing.

Little redheaded boy in Sesame Street underpants:  She really mastered chiaroscuro.

Pimply boy in a dirty, "Satan Lives In Me" T-shirt:  I have always found her work a bit derivative.

Man with molesterstache:  Baroque is her weakest style.

Wholesome brunette mother with small child:  Her perspective improved after her show in Milan.

Smelly obese man in electric wheelchair:  The perspective was intentionally off, you idiot!

Anorexic woman in a thong:  It was part of her gestalt.

Toothless woman with dangling cigarette:  She was trying to demonstrate through art how the world is off-kilter.

Balding myopic man in thick glasses:  That perspective is not to be trusted.

Infant in mother's arms (plucking the pacifier out of his mouth):  Her work on perspective is part of her genius.

The art critique turns to Fauvism versus Realism. Lawn chairs are brought out.  Soldiers and helicopter pilots sit down next to women in curlers and little girls in Barbie nightgowns. Coffee is passed around . The baby takes a cup.

Police Officer #3 is drinking coffee, when suddenly he laughs ruefully and slaps his leg.  He gets up and walks over to Our Hero Derek, RN who is still lying prone in the street.  Police Officer #3 removes the handcuffs from Our Hero Derek, RN, then walks back to his chair, sits down and reaches for his coffee.

The chubby Hispanic boy picks up an M-60 machine gun that has been dropped on the sidewalk. He glances around quickly, then carries it off stage left.

Camera pulls back. Our Hero Derek, RN pushes himself shakily to his feet, his face smeared with blood.   Blood is spattered down the front of his shirt.  Close up of him lifting a hand to his broken nose.  Our Hero Derek, RN staggers off stage right.

Final close up of Police Officers #4 and #3 walking back to their patrol car. The first light of dawn is streaking the sky.

Police Officer #3: (chuckles ruefully) I left a woman being raped and stabbed to respond to this.

Police Officer #4: Yeah?  Well, I left a robbery-turned-triple-homicide.

Police Officer #3: Oh, well.

Police Officer #4: Ya gotta do what ya gotta do.

Police Officer #3: Yeah.

Police Officer #4: Yeah.

(beat)

Police Officer #3: Wanna get a doughnut?

Insane Childhoods

More children than ever are being diagnosed with psychiatric issues like ADHD, ADD, bipolar disorder, anxiety and depression.  As reluctant as I am to side with Tom Cruise on ANYTHING, it is said that even a stopped clock is right twice a day. 

I do think that many childhood psychiatric illnesses are over-diagnosed and over-medicated.  Here is Camille's three-step all purpose guaranteed fix for whatever type of insanity ails your kid:

STEP ONE:

Throw out all electronic equipment such at televisions, DVD players, Iphones, stereos, video games, Wiis, computers, X boxes, Ipads, gameboys, etc.

 If it has a cord, throw it out.

Nurse's Note:  No child should EVER have a television or a computer in their bedroom. Televisions and computers should be in public areas of the house, not only to encourage togetherness and minimize obesity but to keep your kid off the evening news.

STEP TWO:

Come up with a list of daily and weekly chores that will be expected from your child.  Then, FOLLOW UP on your child's compliance with each item on the list. 

This will require some effort on your part as a parent.  But if you can find the time to take your child to a psychiatrist and give them pills to sedate them, you can find the time to teach them how to work.  Help them learn to be productive and to take pride in their accomplishments. 

Stop parenting chemically.

STEP THREE:

Spend time with your kid.  Most of it should be spent outdoors, in nature.  Play a sport together; go for walks.  Talk.  Tell them about yourself.   Listen to their stories.  Share some of your own.

Nurse's Note:  No child under thirteen needs to have a cell phone.  Save the phone as a special birthday present.  Make it a symbol of adulthood.

Voila!  Now your child isn't crazy anymore!  It's a miracle of modern medicine!!

High Anus

Sometime on the news I hear about "high anus" crimes.  I'm not sure what crime has to do with proctology, but I do feel for proctologists.  They are in a high anus business, for sure.

I'm not sure how much proctologists get paid, but it ain't enough.

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.

The Horror

Here's the song that I learned in the nursing home:

Blackjack was one of the residents that was we kept wedged tightly between two pillows on the communal sofa. When he was younger, Blackjack had been a hard-drinking chain-smoking gambler; now he was demented and completely blind.   Throughout the day, Blackjack would call out from the sofa, "Put me to bed! Put me to bed!" his blind, milky eyes staring straight ahead.

Sometimes he would summon the strength to push his frail, shaking body upright and stand there tottering, screaming, "Put me to bed! Put me to bed!" until a nurse or an aide ran up and sat him back down.

Mrs. Maines was wheelchair-bound. She crept around the halls by pushing her swollen purplish feet at the floor, inching along. One afternoon I heard her whisper, "C'mere. C'mere. C'mere."   She was watching me intently, making a beckoning gesture with her gnarled, age-spotted hand.  I bent down and she took my hand weakly.  I thought how lonely she must be, what a dreadful life this was for her.

As I was considering this, Mrs. Maines tugged my hand, up, up--to her open mouth full of broken, blackened teeth. 

She was trying to bite me!  In slow motion! 

I jerked back, aghast, and stared at her.

"C'mere," she whispered, beckoning. "C'mere. C'mere."

"Put me to bed! Put me to bed!"

"C'mere. C'mere. C'mere."

Hayden was a very sweet, childlike man with a severe mental illness. Years of anti-psychotic drugs had given him tardive dyskinesia; his tongue seemed too big for his mouth. His few words came out very loud and very wet, like a sadistic imitation of Yosemite Sam.

Hayden was obsessed with changing his clothes.  Sometimes he changed them ten times a day.   Since he lacked the fine motor skills necessary for buttons and zippers, he would wander the halls with his pants falling around his knees and his shirt hanging open. When he saw a staff member he liked, he would approach and say, "MA'AM? PBBBTHHHHHHH! MA'AM? PBBBTHHHHHHH!" saliva spraying with each, "PBBTHHHHHHH!"

He would gesture at his falling pants, indicating that he wanted them to zipped and buttoned.   At first I felt  awkward groping with a man's pants in the middle of a busy hallway with staff hurrying by and residents sitting everywhere. But after the sixth time in one day, my shyness vanished.

"Put me to bed! Put me to bed!"

"C'mere. C'mere. C'mere."

"MA'AM?PBBBTHHHHHHH! MA'AM?PBBBTHHHHHHH!"

Pauline had severe diabetes that had been poorly controlled for years. As a result, one leg had been amputated; she was nearly blind and had suffered a stroke.  Pauline sat in her wheelchair all day, like an obese one-legged idol, calling out plaintively: "Juice! Juice! Please! Juice! Juice!"

"Put me to bed! Put me to bed!"

"C'mere. C'mere. C'mere."

"MA'AM?PBBBTHHHHHHH! MA'AM?PBBBTHHHHHHH!"

"Juice! Juice! Please! Juice! Juice!"

One afternoon I was at the desk poking dispiritedly at paperwork when a resident approached. She had a some kind of mangy dead animal wrapped around her neck.  It must have died of rabies because it was biting its own tail. She leaned over the counter and said loudly, "I'M SUPPOSED TO BE LEAVING NOW. I NEED YOU TO CALL MY DAUGHTER. SHE IS COMING TO GET ME. YOU NEED TO GET MY THINGS TOGETHER. I'M GOING TO BE LEAVING NOW."

I dropped the papers.

I had never discharged anyone; I had no idea what the proper procedure might be. What was legally required to send a resident home with her family? Was she leaving for good, or just for an overnight visit?   As the only RN in the facility, I was supposed to have the answers, knowledge and education to handle this.

I was quite sure that I had all the liability.

I stood up, trying to think. The woman repeated, "IF YOU CALL MY DAUGHTER SHE WILL COME AND GET ME. I AM SUPPOSED TO BE LEAVING. YOU NEED TO GET MY THINGS TOGETHER."

Unable to think of anything else to do,  I started rooting around for her chart.  Maybe she went home regularly.  Maybe her daughter knew the proper papers, forms, etc. that she needed to sign to take her mom home. 

The woman reached her hand out, urgent.  "I NEED YOU TO GET MY THINGS TOGETHER. MY DAUGHTER IS COMING FOR ME.  I AM GOING TO BE LEAVING NOW."

She was obviously extremely hard of hearing, so I nodded and smiled and waved.

I found the chart.    It was covered in red tape.  The tape was criss-crossed over the front, back and spine.  And there were words written on the tape, over and over, on each strip were the words, "DO NOT CALL PATIENT'S DAUGHTER".

"Put me to bed! Put me to bed!"

"C'mere. C'mere. C'mere."

"MA'AM?PBBBTHHHHHHH! MA'AM?PBBBTHHHHHHH!"

"Juice! Juice! Please! Juice! Juice!"

"MY DAUGHTER IS COMING FOR ME. YOU NEED TO GET MY THINGS TOGETHER. MY DAUGHTER IS COMING FOR ME."

11 minutes before my shift ended, someone touched my arm. I lunged back violently, like an abused animal anticipating the worst.  Mrs. Maines had already snuck up on me twice that day, pulling weakly at my sleeve, trying to get some part of me into her mouth.

This time it was a old lady with hair dyed a shade of red incompatible with life.  Since she wasn't trying to bite me, I steadied my breathing and tried to recall that I was a nurse.

The woman stood there, looking soulfully into my eyes.  Then, she shook her head and said sadly, "I love you even though you've turned against me."

The horror. The horror.

Warehousing the Undesirables

When I became a nurse--back in the Peloponnesian War--we were told that there WAS no nursing shortage.  Hospitals were cutting nursing positions; the market was flooded with experienced nurses who had been let go.  Jobs were hard to find.

I was single with two small daughters.   I applied at every hospital that had its lights on.  After sitting next to a silent phone for a few days, I decided that I really do like to eat on a regular basis.  So, I filled out an application at a nearby nursing home.

The manager fanned her magenta cheeks with my application, pulled open her file drawer with her foot and dropped the paper in. "You get three days of orientation," she said.  "Start tomorrow."

On my first shift I oriented beside an LPN for eight hours.  The second day I was supposed to be with an RN, but after four hours she had to leave to deal with a family crisis, leaving me to blunder about on my own for four hours.   On the third day of my orientation, my assigned preceptor did not show up at all.

And that was it.  On my fourth day--my fourth shift as a new nurse--I was told that I was going to be the "charge nurse" since I was the only RN in the building.  A nursing home has to have at least one RN.  I was in charge over the LPN's and the nurse's aides.

Those that had shown up for work.

I learned a lot in that nursing home.  It has impacted my nursing practice and my outlook on life.  I worked there for three weeks and five days.  Then, my phone rang.  A hospital nearly an hour away had an opening on their oncology floor.

Like Bugs Bunny in a cartoon, I ran straight through the wall on my way out, leaving a punched-through outline of myself behind.

The people in a nursing home are not called, "patients", because they are not sick in a hospital.  They are called, "residents" because this is their home where they reside. 

The nursing staff turns over constantly.  In the three weeks I was there I saw four aides and one nurse come and go.

Every morning I trundled a medication cart wildly through the halls, madly throwing drugs around like a crack dealer with ADHD.  In nursing school we were taught that medications could be given in a thirty-minute window either side of the hour they were due but NO MORE AND NO LESS.   But nursing home residents are all on about 152 different drugs, so it takes a long time to prepare and administer them all.   If I started shoving medications at residents the very second I stepped across the threshold at 06:58, I was lucky to be finished by 11:00.  When I needed to start the midday med pass. 

It was also drilled into us in nursing school that medications are to be given one at a time.  The nurse is to discuss each pill--what it is and why it is being prescribed.  I tried that.  I explained selective serotonin reuptake inhibitors and betablockers and clotting cascades and angiotensin converting enzymes to a resident who listened in a friendly, interested manner, then offered me a handful of stool from his brief.

It was 08:49 and I still had 37 patients to pass pills on.  I altered my methodology then, and started doing what the LPN's were doing--pawing madly through the MAR, pouring pills into cups, thrusting them at the residents and moving on.

Nursing home residents do not wear wristbands.  It is considered demeaning to put ID on someone in their own home.   This might be good for the residents's self-worth, but it is a a nightmare to the nursing staff trying to confirm who is who.  Lots of the patients are confused or nonverbal.  Often THEY don't know who they are.  Some of them are mobile, wandering up and down the halls and in and out of each other's rooms.

The resident who lived in room 64 was Shirley Buckley.  The second morning that I worked there, I saw that she had 16 different pills due at 09:00.  I put them into a little white paper cup and handed it to the wheelchair-bound woman in room 64.

She took them with a shaking hand, stared at them for a moment, then muttered, "These ain't mine."

I was getting the next patient's medications together.  It was common for one medication cart to run out of potassium and we would steal it from another cart.  I was trying to remember which cart I had stolen the last doses of potassium from.  It's best to rotate.

Distracted, I said, "Yes they are.  Take them."

She shook her head and repeated, "These ain't mine!"

I was opening my mouth to argue when an aide hurried by.  The aide paused long enough to say,  "Now, Melva, you take your medicine!"

My heart skipped twice.  I snatched the cup of pills back.

Nursing homes like to advertise themselves as, "restraint-free".  That sounds nice when you are trying to keep your beds full and avoid a One Flew Over the Cuckoo's Nest- type of image, but a system where staff cannot use actual restraints will result in falls.  Lots of falls. 

Falls are considered very bad in any medical institution.  It is kind of a Catch-22:  the resident cannot live at home safely--very often because they have fallen and been injured--so they are placed in a nursing home.  In the nursing home they cannot be restrained in any way.  Despite the fact that now they are even older and more debilitated, they can't be restrained but they mustn't fall. 

In a very typical human fashion, the staff circumvents this impossible standard by using "restraints" that are not true restraints.  Residents are parked at tables so they can't push themselves up and topple over.  A sheet is tucked around them like a seat belt.  Pillows are wedged beside them snugly to make it difficult for them to stand.

Despite all those efforts, falls are common at nursing homes.  It seemed like not a day went by without someone falling--either out of bed, out of a chair or in the hall.  Unless every resident was kept on a leash by their very own personal staff member, there were going to be falls.

The nursing home had a locked Alzheimer's ward.  Ralph lived there, all six feet four inches of him.  Before he came to the nursing home, Ralph was a soybean farmer.  Now, he was a CIA agent.  He often talked about his years in the CIA as he paced the unit restlessly.

The first day I was assigned to the Alzheimer's ward, I prepared Ralph's medications carefully and presented them to him in a little white paper cup.  Ralph was walking about listlessly. 

"Go away," he told me, waving one hand dejectedly.

In nursing school, we had been heard many lectures about how patients always have the right to refuse medications and how to document the refusal.  I confidently took the rejected cup of medications and disposed of it in the hazardous waste container.  Then, I carefully circled 0800 on the MAR and wrote, "refused" by each entry. 

At 1200, Ralph had several more pills due.  I noticed that he was agitated and pacing wildly now.  He seemed pretty excited.  As I approached with the cup of pills, Ralph threw up his arms and said, "Go away!"

Again, I pitched the drugs and documented, "refused" on the MAR.

By 1600, Ralph was charging around the unit, kicking over chairs and knocking into unsteady old folks.  He saw me approaching him from across the room with another cup of his medications.  He started pawing at the air and yelling, "GO AWAY!!  GO AWAY!!  GO AWAY!!"

Shaking, I walked back to the MAR to start circling.  Liz, one of the LPN's, had heard all the ruckus.  She hurried over and saw my MAR.  She said, "What are you doing?"

I started explaining how Ralph had refused his medications---but she interrupted me.  "You can't do that!  You can't do that here!" 

She took the pills from me, crushed them expertly and mixed them with some vanilla pudding.  In nursing school we were taught that you NEVER hide medications in food or drink.  I watched, astounded by how swiftly it seemed that everything that I had learned was being cast aside.

Liz walked right up to Ralph and slid her arm confidently around his waist.   Ralph, who had been pacing and waving and yelling at an invisible enemy a moment before, froze as her curves pressed against him.

Nurse's Note: A CIA agent's weakness is always a woman.  Remember James Bond?

Liz said in a low, husky tone, "Hey, Ralph, I just made this.  Would you taste it for me and see how it is?"

Ralph stood there like a stunned sheep and docilely ate every bit of the pudding/pill mixture.  Liz gave him her most beaming smile and said, "Thanks, Ralph!" 

He smiled vaguely.  Some pudding was smeared down his chin.

Liz walked away and I trotted after her, chastened.  When she paused by the med room, I said, "Thank y--" but she cut me off.

"Look, I don't know where you went to school or what--" she glared at me like I had just raped her dachshund. 

"Don't do that again," she said.

Health Care History

Over the centuries, medicine has evolved and physicians have evolved with it.  Here are early prototypes of medical specialties:

Surgery

Anesthesia

OBGYN

Neurosurgery

Orthopedics

Internal Medicine

And Pulmonary.

Physicians have a peculiar vulnerability to the whims of fashion. 

This phenomenon can be manifested in clothes and transportation...

 or the absence of them...

Parking difficulties have always been closely linked with medicine...

Hippocrates is called the Father of Medicine.  He faced many challenges in Ancient Greece. 

For one thing, getting the snake on the caduceus was difficult... 

It is from Hippocrates that we get the Hypocritical Oath that all physicians must take.

Dr. PetPeeve

I think that the relationship between physicians and nurses has come a long way over the years.   There is more collaboration now and less opposition.  I work at a teaching hospital, and for the most part, we all get along well together.  

I do, however, have three major pet peeves where physicians are concerned.

The first thing I'm going to bitch about is the computer.

There are 29 computers on the ICU where I work.  When patients are climbing out of bed, call lights are blaring, IV pumps are alarming and a doctor comes and plops his ass down at the computer I'm signed onto, my hand reaches spastically for a large bore needle and adenosine.

Several vials of adenosine. 

My bag and my stethoscope are lying right next to the keyboard in plain view.  What should I read into this behavior?  

Has my touch rendered this ONE computer into a SUPER COMPUTER?  Will orders placed on THIS computer result in a miraculous cure, the patient leaping out of bed, embracing staff, rushing home and donating a quifazillion dollars to the physician?

I guess I can see the appeal.

Or, perhaps the physician is is just too damned self-important to see that I have been working from that very spot all night? 

Move your educated ass 27.9 inches down the desk.  Find a computer no one is using.

Ain't you got no raisin'?

The second thing I'm going to bitch about is IV push pain medication, like fentanyl.  


Too often I see the order, "Fentanyl 25-50 mcgs Q 1 hour PRN".  In some alternate universe where god is a nurse, computers would be wired to deliver a 53,956 joule shock to anyone placing that order.  An white-hot bolt of electricity would shoot up from the keyboard, stopping their heart. 

For good.

If they have one.

In case there are any doctors out there who grew up in a burlap bag prior to residency, here's an update:

Narcotics are abused, so they are tightly controlled.  IV narcotics are VERY closely monitored, checked and cross-checked.  They are watched as obsessively as the waistline of a Bel Air trophy wife.  

Fentanyl only comes in 100 mcg vials.  If a doctor writes, "Fentanyl 25-50 mcgs Q 1 hour PRN", then every time the patient needs pain medication the nurse has to grab another nurse--taking them away from whatever they were doing--drag them along with her to the pyxis, withdraw a vial of fentanyl, pull the drug up in a syringe, waste the appropriate amount in front of the other nurse, have the other nurse sign for the waste in the pyxis's computer, then go give the dose.

Sound complicated?  Time consuming?  Wasteful of not ONE but TWO nurses's time?  It is!  And yet, if you order fentanyl every hour, that little dance must be repeated every hour.  With two nurses.

As a result, many nurses just pull out the vial of fentanyl, give the ordered dose and then put the vial with the remainder of the drug in their pocket or in the bedside server.  They know the patient will want more in about 45 minutes. 

But legally, fentanyl cannot reside ANYWHERE other than in the pyxis, in the patient or wasted down the sink.

This is a perfect example of how bad orders create an environment where narcotics are NOT properly handled because doing the right thing is just so damned inconvenient.   Stop threatening the nurses's licenses! 

If the patient is in enough pain to warrant an order of Q1 or Q2 hours of a controlled substance, order a PCA.  The drug dosages and frequencies can be exactly the same, but it is MUCH less work for the nurse. 

The PCA is set up, the patient gets their little button, the narcotic is secure, the nurses can actually do some work instead of standing in front of a pyxis watching and witnessing fentanyl being wasted, and everyone is happy.  Smiles all around!



Here's my third pet peeve:  verbal orders. 

About verbal orders, I don't like 'em.  

I have once--just ONCE, mind you, but that's really all it takes--had a physician deny that they gave me an order.  It's ugly.  The resident in question gave an order in the night, and when staff arrived in the morning and raked him over the coals his response was to protest that he never told me to do that.  It was all the nurse's fault!  He was innocent! 

That's a pretty serious charge.  "Practicing medicine without a license", I believe it is called.  It all might have turned out badly for me--ending with my children being raised in a homeless shelter--except there were four other nurses involved who had witnessed the whole thing; one had actually taken the phone orders from this dickless shithead when I was in the patient's room. 

All the nurses involved were brought in, questioned, fingerprinted, and waterboarded by our nurse manager, the parking attendant, the state police, the FBI, the CIA, the ACLU, the KGB and the PTA.  We signed statements and held up our right hands and sang songs and pledged allegiance.   

When faced with this avalanche of testimony against him, this asshole--sorry, I meant to write, "doctor"--said that he had been asleep and he must have just forgotten the whole thing. 


I've had physicians protest on the phone that they can't put in an order in because they are busy placing a line or coding a patient.  But, I can read "STAFF LOUNGE"  on the caller ID. 

My trust level with verbal and telephone orders is pretty low.  Avoid the infamous, "He said, she said," cliche. 

Put your own orders in under your own name.