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.

Omas

Nurses always have some good medical stories, and late one night the talk turned to, "homeopathic remedies".  We laughed about at the suckers who spend their life savings on an Ancient Mayan Cures, Tai Chi Teas and All Natural Herbal Remedies. 

Nurse's Note:  synonyms for the word "homeopathic" are "charlatan", "mountebank" and "rip-off"

One nurse told us about a family member who  had spent thousands of dollars on a device that made their drinking water alkaline.  The rationale behind it was vague--but the water reportedly tasted awful and made the whole house smell like a rotten egg.

When I asked why they were willing to pay for such an transparent scam--since the body's acid/base balance system would render the impact of drinking alkaline water negligible--he told me that his in-laws think that drinking regular water causes animal tumors.

That seemed so funny to me that I started drawing animal tumors. 

Here they are, a whole Oncology Ward full:

Platypoma

Octopoma

Armadilloma

Rhinoceroma

Peacockoma

Kangaroma

Walroma

Stegosauroma

Narwhaloma

Pegasoma

These animal tumors can occur in vulnerable children who are not drinking alkaline water.

Bearoma

Tyrannosauroma

Dating can be difficult with an animal tumor...

Breaking up with an animal tumor is also difficult. 

Try to live an authentic life despite your  animal tumor!

Enjoying life with a hippopotopoma

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

Pain in My Ass

Do you know what my three favorite diagnoses are?

I'll give you a hint:  they all only occur in first-world countries.  They are strongly linked to obesity, depression and anxiety.  And there are no laboratory tests, scans or xrays that can reveal them. 

They are only diagnosed by ruling out other possible causes.  They are then, "default" diagnoses.

Nurse's Note: "Default diagnoses" come and go fashionably.  What ever happened to Chronic Fatigue Syndrome? 


Okay, here they are, my top three:

1.  Cyclic Vomiting

Do you know what will stop cyclic vomiting?  Four milligrams of hydromorphone pushed intravenously.  Hydromorphone is an powerful narcotic given to people dying of pancreatic cancer or who have had their leg chopped off by a chainsaw. 

And, for cyclic vomiting. 

Note: you will never actually SEE these patients vomit, though they complain of constant nausea.  And there is always, ALWAYS a hovering enabler with them, usually a woman.

Do you know how to spell, "cyclic vomiting"? 

"F-A-K-I-N-G-I-T"

2.  Pseudo-Seizures
 

A patient with a real seizure disorder has a big problem.  Since they may seize at any time, their lives are extremely restricted.   They can't drive; often they can't work.  If we can discover EXACTLY where in their brains the seizures are coming from, neurosurgeons  can resect that area and the patients can stop their anti-seizure medications and live normal lives. 

To find out where these seizure "storms" are coming from, we bring the patients into the hospital and stop all their seizure medications.  We hook them up to a continuous EEG monitor and wait.

And wait. 

And wait. 

It’s the, "watched pot never boils" syndrome.  It can take weeks, but we have to get three seizures on the EEG strip.  We keep the patient up all night, stimulate them with flashing lights, noise, television, anything, trying to get them to seize.  It’s frustrating for everyone.

A patient with pseudo-seizures is different.
Nurses can always tell within 7.1 seconds if the patient has pseudo-seizures. You walk into the room and before you can say, "Hi, I’m your nurse--" they will have a "seizure".  They will prove it to you! 

Questions asked during this "seizure" often get answers.  If you lift up their arm, hold it over their face then drop it, the arm won’t hit their face.  It will fall beside it. 

What will cure pseudo-seizures is pushing two milliliters of normal saline IV while loudly announcing, “This will stop it if it is a real seizure”. 

The seizure will always stop.  

Do you know how to spell, "pseudo-seizures"? 

"A-T-T-E-N-T-I-O-N-S-E-E-K-I-N-G".

3.  Fibromyalgia

My third, most very favoritist diagnosis in the WHOLE WORLD is fibromyalgia!!  These patients have chronic pain.  They just hurt everywhere!  They can’t have a job because of their "illness".  Nothing can ever be expected or demanded of them.  Their  list of pain medications and anti-anxiety medications and anti-depressant medications is as long as the Trans-Siberian Railroad.  And they are just nearly always single, obese white women who watch a lot of daytime television. 

They will ask you point-blank to push their drugs fast into the closest IV port for the rush.   If they are conscious, they are miserable.   Do you know how to spell, "fibromyalgia"? 

"D-R-U-G A-D-D-I-C-T”
 

Not one person living in Leningrad in 1942 had cyclic vomiting.  No one in Andersonville prison during the Civil War had pseudo-seizures.  And no Libyan woman trying to escape a terror regime with her children had fibromyalgia. 

Maybe it’s our latitude?

The Fibromyalgia Fairy

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

The Third Law of Thermodynamics

Dr. Walther Nernst proved with the Third Law of Thermodynamics that absolute zero can never be reached in a finite number of steps.  But, Dr. Nernst was a physicist, not a nurse.  He obviously never had to chart on nursing care plans.  Absolute zero may not be possible with the laws of our universe, but nursing care plans come mighty close.

Nursing care plans are a complete waste of time.  They are double charting, which we vowed to get rid of years ago.   The time I spend charting on care plans could be used doing something useful, like picking my nose or wondering if I need to buy more dish soap on the way home.

Care plans were actually thought up by a fellow nurse!  I hope her PhD was worth it.

 

(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.