Forbidden Language in the ICU

Last night, a fellow ICU nurse referred to his genitalia as his, "Wee Wee".  I am pretty far from being a prude, but there are some words that ICU staff just cannot use. 

Here are a few of them:

Now that we are responsible for people's lives, let's use our big boy and girl words.  I'd rather hear, "Dammit!  There is shit all over the bed!  AGAIN!"

Topekanese

I work with nurses from many foreign lands, like Nigeria, Ukraine, Mexico, India, Sierra Leone and Topeka. 

The nurse from Topeka is graceful and athletic, with glowing skin and very white teeth.  She looks like a ballerina who took a wrong turn after rehearsing Swan Lake and ended up staffing in the ICU.

They do speak English in Topeka, but it's a dialect I am not very familiar with.  The dialect--Topekanese--contains some strong phrases that seem incongruous coming out of this young woman's mouth.

When she hears about a challenging admission, she remarks cheerfully,"That sounds like a shit show!"

If a co-worker comes in unshaven, she says, "What's with the trash 'stache?"

If she hears something that sounds like mendacity, she says, "He pulled that straight out of his asshole."

If someone says something unkind, she says, "I'm really butt hurt about that."

I thought I might get me a hernia from laughing so hard.   In an attempt to understand her culture better,  I did some research on her native land. 

Topeka is located in the middle area of the United States of America.  It's somewhere between New York and San Francisco, Austin and Minneapolis.  It is south of Chicago, but north of Miami.  It is east of Phoenix but west of Atlanta.  It is closer to Denver than it is to Portland.

The state dog of Topeka is the Topekingese.

The state bird is the Topeking duck.

The state flower is the Topekawinkle.

Now, we all know more about the great state of Topeka!

Back Rub Etiquette

I enjoy back rubs, but sometimes when a co-worker is massaging my back, I start to wonder--where are the boundaries on a woman's back?  How far around the side and down the front is permissible?  Lower than the collar bone?  Farther around than the mid-axillary line?  Or the phlebostatic axis?

To clarify this puzzling issue, I came up with a chart to illustrate the DANGER ZONES  not to be breached in back rubs:

DANGER!!

Side View (Left)

DANGER!!

Rear View

DANGER!!

Front View

I asked my husband what he thought the perimeters should be when a guy rubs my back.

 

He touched the very center of my back and said, "Right there.  That's the limit."

I think he's anti-research.

Peer Parking

Last week I met a friend for lunch at her workplace.  She does research in a huge science laboratory supported financially by a private endowment.  The building takes up several city blocks and is full of sculptures, paintings and fountains.

I managed to find the parking garage,  but then I realized that a badge was necessary to park on certain levels.  Signs were up directing traffic to the appropriate area.

I knew where I needed to go.

Playing Telephone

Last night I called a doctor about getting a drug ordered for my patient.  The day shift nurse had attempted to get the medication ordered but had no success.  After arguing with me for a few minutes, the physcian said, "Okay, fine!  She can have it, then!"

I said, "Great!  Are you going to put that order in?"

He said, "I, uhh--I'm not near a computer.  Can you do it?"

I said, "I'm not, either."

He said, "I'm placing a central line."

I said, "I'm coding a patient."

He said, "I'm resecting a brain tumor."

I said, "I'm fighting ninjas."

He said, "I'm performing open-heart surgery."

I said, "I'm taking off in the space shuttle."

I said, "Losing you...zzzzzzkk...can't hear...zzzzzkk...put in order....zzzzkk..."

All communication was lost then.  I guess he didn't understand, because he didn't put the order in. 

I waited an hour and paged the oncoming resident to put it in.

Reception is so sketchy out there in space.

English Lesson

I often hear my co-workers complain about patients who don't speak English.   But, I talk to nurses every day who don't speak English very well.

When studying a foreign language, you learn practical phrases like, "Where's the bathroom?" and, "Please give me two boiled eggs."  They never teach you how to say, "Did your great-aunt on your mother's side plant anemone along her back terrace?"

Here some common English phrases that need their usage clarified:

"Hi, how are you?"  (HY' hauw-r-u)  This is a commonly misunderstood phrase, commonly confused with, "I give a shit about your personal issues and I want to hear your woes."  That is an inaccurate translation.  "Hi, how are you?" means, "Hello".  The correct response in English is: "Fine!  How are you?"

"Well" (WE' ul')   If you have diarrhea of the glottis and you are rambling mindlessly on and the glassy-eyed person in front of you says, "Well"  it DOES NOT indicate agreement.   "Well," is actually a contraction.  The uncontracted version is: "When will he shut the hell up?"  

 "Huh" (HU')  "Huh" is Latin.  It means, "I heard you."  That's all it means.


Communication is a two-way street, though.  Lots of people don't know how to listen.  If a friend starts telling you about his wife cheating on him, his mother dying of cancer or his house being repossessed, do this:  sit still with your eyes fixed on him.  Nod occasionally.  Keep your mouth shut.  DO NOT offer any advice, criticism or comments.  Do not text, phone anyone or look around. 

See below.

Now, you're a great listener!

The Ivory Tower

Nursing has its very own Ivory Tower.  Staff nurses toil away in the Tower's shadow; missives come from high above to guide our nursing practice. 

At the top of the tower is one tiny peephole, which allows a few beams of sunlight in at 11:47 a.m. 

The rest of the time the Tower is in darkness.

Seven Dwarfettes

Snow White and the Seven Dwarves is the story of a teenage girl who doesn't get along with her stepmother, runs off and moves in with seven single men.  

I don't agree with reading that kind of thing to children.  But, women read Fifty Shades of Grey in public, so I guess I don't know.

But, I digress--after Snow White married Prince Charming and was carried off into the sunset, all of the Seven Dwarfs got married.  Yep, every one of them found his own dwarfette!

Each of their relationships had challenges, though.  Each of their challenges mirror issues that persist between men and women today. 

See is you can match each of the Seven Dwarfettes to her respective husbands, and if you recognize the problem in their relationships. 

Remember, the Seven Dwarfs were Doc, Grumpy, Sneezy, Sleepy, Bashful, Dopey and Happy.  

1.  Bitchy

2.  Dizzy (this is her third marriage)

3.  Dolly

4.  Shy

5.  Dreamy

6.  Jolly

7.  Silly

Answers:

1.  Bitchy/Grumpy

2.  Dizzy/Sneezy

3.  Dolly/Doc

4.  Shy/Bashful

5.  Dreamy/Sleepy

6.  Jolly/Happy

7.  Silly/Dopey

So, how did you do?

Be a G.O.A.T.!

One of the biggest problems with American government is that senators and representatives spend so much time and money trying to be re-elected.   This causes our leaders to be very vulnerable to special interest groups; it is a system that almost guarantees corruption.   

Let's get rid of professional politicians once and for all!  Here's an idea for a government of the people, by the people and for the people:

The local, state and federal government offices are now going to be selected by lottery of everyday folks.  If your name is drawn, you serve your country by working in the government for one month. 

Like this:

An envelope comes in the mail; you open it and read that you are going to be a local representative this month.  Or maybe you're going to be the deputy mayor.  Or the lieutenant governor.

"Honey, looks like I gotta go to Washington and be a senator next month...can you take Puffy in to be neutered?" 

There would be less corruption with that kind of short term.  People would stay in tune with the issues and they would have a chance to be involved with the government process first-hand.  Efficiency would improve; there would be no motivation to stall or filibuster.

At the end of your month of service, you would get paid 1/12th of the average American yearly salary.  Your job back at home would be held just like if you had been called to jury duty.  The cush senators salaries and retirement plans and special medical care would be GONE!

We could call ourselves the "G.O.A.T. Party":  Government Of American Taxpayers!  It would really be a government of us!

G.O.A.T. Party

To be G.O.A.T. you have to meet certain standards:

High School graduate or G.E.D.
Literate in English
Gainfully Employed
No Felony Convictions
25-75 years old



Nurse's Note:  I know this will never happen; it takes at least a month just to find the bathroom in the Capitol Building.  But seriously, let's vote in Campaign Finance Reform.  Be a G.O.A.T.!

Ex-Husband Line Up

I saw my ex-husband last week.  When I pointed him out to my present husband, my present husband said, "Uhh...I don't think that's him.  Are you sure?"

I said I was pretty sure.  I can usually recognize EVERY person I have ever been married to!  It's some kind of perceptive gift, like those autistic people who can multiply large numbers in their heads.

If you put all my ex-husbands in a line up with other men, I could pick out nearly every one.  EVERY ONE!!

Ex-Husband Line Up

Pandimensionality

I have been a nurse for a long time, but until last night I had never heard of The Science of Unitary Human Beings.   This "nursing theory" is being taught at colleges across the country.   Students are paying exorbitant prices to to go to nursing school and they are getting, "pandimensionality"? 

What?

This "theory" has lots of big, important-sounding words like:  Helicy, resonancy, integrality, energy fields, rhythmicities, continuous dynamic metamorphosis, homeodynamic postulates, irreducible wholes. 

Sound confusing?  Like some pretentious idiot masturbating with big words?  Confusing obscurity with profundity?

 Ms. Rogers, the guru who founded this "nursing theory", also has a "Theory of Paranormal Phenomena". 

Here's Wikipedia's definition of Paranormal Phenomena:  This theory focus on the explanations for precognition, déjà vu, clairvoyance, telepathy, and therapeutic touch. Clairvoyance is rational in a four dimensional human field in continuous mutual, simultaneous interaction with a four dimensional world; there is no linear time nor any separation of human and the environmental fields.

Science has debunked every one of those, "Paranormal Phenomena".  None of the phenomena identified by the Concept of Pandimensionality has ever been proven by science; quite the opposite.  Rigorous blind testing using the scientific method has repeatedly demonstrated that paranormal phenomena are an illusion fostered by fraud or ignorance. 

Here is Mosby's Dictionary of Complimentary and Alternative Medicine definition of pandimensionality:  the science of unitary human beings, the non-linear, non-spatial, non-temporal reality underlying the realm of everyday experience.

Does any of that make sense to anybody?

Is this really being taught in an American higher education by professors?  Can they really spout off this bunk with a straight face?  Here's a question for any professor teaching the Concept of Pandimensionality: 

Do the words coming out of your mouth travel around to your ear?  Or do you have on  a white plastic collars like they put on dogs so they can't lick their stitches--but you wear it hitched forward so your ears are on one side and your mouth on the other?

The Theory of Pandimensionality


Nurse's Note:  I wish nurses would stop working so hard to add more letters behind their names and put more effort into keeping their patients turned, poop-free, heparin drips titrated correctly and another bag of levophed available. 

You Know it is Going to Be a Bad Night When...

After many years as a nurse, I believe in portents.  I used to scoff at superstitious nurses, but now I watch for ominous signs indicating that my shift is going to be bad.

Here are some telling omens:





Omen #1:  You Can't Find a Parking Space in the Parking Garage

Omen #2:  The waiting room is full of crying family.  One of them is on the floor.

Omen #3:  Two attending physicians are standing outside your patient's room

Omen #4:  The code cart is parked inside your patient's room

This is a good time to suddenly feel very sick and need to go home. 


             

Therapeutic Heroin Levels

Sometimes, it is difficult to organize your thoughts into anything coherent after a long, difficult shift.  One morning, I was giving report to a day nurse and I said, "The patient is therapeutic on heroin, so the next PTT will be tomorrow morning."

The oncoming nurse looked at me strangely.  

I corrected myself hastily.  "Heparin!  Heparin!  They're therapeutic on heparin!  I don't actually know what their heroin level is..."

It caused me to wonder--what IS a therapeutic heroin level? 

I did some informal research on this burning topic.  The nurses all had different answers, but the best response was, "Somewhere between remembering to brush your teeth and chewing some guy's face off."

So, here's the scale:

Supratherapeutic:

 

     Subtherapeutic

A Plethora of Physicians

Groups of animals are called by different names, depending on the type of animal.  There are herds of horses, schools of fish, packs of dogs, prides of lions and litters of kittens. 

Some of the names are very quaint and unusual.  Like, a parliament of owls.  A murder of crows.  A vagrant of sea urchins.  A loveliness of ladybirds.  A battery of barracudas.  A mischief of mice.  A quiver of cobras.  A puddle of platypuses.  A storytelling of ravens.  An exaltation of larks.  A pandemonium of parrots.  A congregation of alligators.

As medicine advances, there are more and more physician specialties.  Every square millimeter of the human body has a group of physicians to rigorously study and care for it. 

To keep all of these physician specialties organized, the American Medical Association has assigned names to each group, just like animals have.  Now, it is all crystal clear!

A boob of plastic surgeons

An pulse of vascular surgeons

A fart of gastroenterologists

A gout of rheumatologists

A fundus of obstetricians

A toddle of pediatricians

A fracture of orthopedic surgeons

An abcess of peridontists
A clot of hematologists
A pimple of dermatologists
A fever of infectious disease physicians
A heartbreak of cardiothoracic surgeons
An id of psychiatrists
A snore of anesthesiologists
A colon of proctologists

A tumor of oncologists

A puff of pulmonologists
A speculum of gynecologists
A dribble of urologists
A crash of trauma surgeons
An arrogance of emergency room physicians
A fifth of hepatologists
A shock of cardiologists
A bunion of podiatrists
A comfort of palliative care doctors
A cataract of opthamologists
A trach of ENT surgeons
A seizure of neurologists

Pick Two, One Blue

In my line of work, I deal with a lot of people.  Some are brilliant, some are--well, some are not brilliant.  That's okay.  Not every nurse or doctor is going to have profound insight.

But, I want to be very clear--if you are not an absolute rock star at your job, you had better damn well be nice. 

Think of it this way:  there are four possible cards.  You get to pick two cards, but at least ONE of the cards you pick needs to be a blue card. 

You can be really good at what you do and a complete asshole.  Or you can be a nice guy who is just a bit on the slow side. 

Nurse's Note:  In a perfect universe you could be a pleasant person who also happens to be competent.  I read somewhere once that this was possible.  

But you cannot be a dickhead  AND incompetent.  That's just over the line.  It's legal to shoot such people in 47 states and the District of Columbia.

Pick two, one blue.

A Well Done Detective Story

It was late at night on Breadbox Street. I reached for a bottle of Nik-L-Nip, broke it open and drank it down.

My name is Gingerbread. Gingerbread Man. Some folks around this mess hall call me, "The Man". "Gin" ain't just my first name; it's my main ingredient.

I'm a private eye. I've been told I'm hard-baked. I tell them I'm just looking for answers. I'm looking for answers at the bottom of a bottle.

In the distance, a kitchen timer goes off.

Another bottle of Nik-L-Nip drowns out that sound very well.

I was slumped over my desk like an underdone brownie when SHE walked in.

She had lemon drop hair and her icing was spread all the way down to THERE. They must have broken the cookie cutter when they made her, because I had never tasted a confection like her.

It felt like someone had just turned the oven on to PREHEAT.

"Mr. Man?" her voice was like spun sugar.

"Yeah?"

"I'm Cinnamon Swirl. They call me, 'Cinn'."

I bet they did.

"Please help me! I'm in so much hot water!"

My heart crumbled like a moldy biscuit. "Look, honey--"

"My husband has been murdered!"

"Murdered?" That sounded like a recipe for disaster.

A syrupy tear ran down her cheek. "Yes! And that half-baked policeman--"

"Captain Dough Nutt?"

"That's the marshmallowhead! He thinks that I did it!"

She melted against me like glaze on a hot cross bun. "Will you help me?"

I was whipped. Like cold egg whites.

I realized later that I must have slipped into a diabetic coma, because all I could think to do was answer, "Yes!"

At the scene of the crime, someone had cooked up an awful mess. Milk was splattered everywhere, and it was not the milk of human kindness.

The late Mr. Swirl's feet were sticking up out of the cup.

A familiar batch of characters had gathered 'round. Dr. Sourpatch was examining the leftovers.

"Is he toast, Doc?"

"He's done," Sourpatch said crisply.

Nurse Coco Nutt flaked by with her gooey smile.

I have always suspected that she was microwaved rather than baked. But, she is sandwiched through matrimony to the law, so I keep my opinions about her lack of raising to myself.

"Always a cookie, never a cook," Nurse Coco Nutt bubbled.

It was a tasteless remark.

Nurse Coco Nutt's husband, Captain Dough Nutt, rolled up.

The heat was on Cinnamon Swirl.

"Ma'am, we need to hash this out."

Cinn froze. "Oh! I'm so afraid of being burned!"

"You ain't hashing, mincing, chopping or dicing," I ground out scorchingly.

If he thought I was going to coddle him because of his little star, his head must be parboiled.

"Men! Men!" It was Old Man Fudge Dropp. He was so old it was rumored that he had been cooked over an open fire alongside a dinosaur cutlet. As the years had gone by, he had become flavored with sage.

Old Man Fudge Dropp gestured to his granddaughter, Kandi Korn. Kandi Korn was playing in the flour bed with her dog, Sprinkles.

"There are gingersnaps in the kitchen," he said. "Be sweet."

Now, that really crimped my crust. No one has ever said that I don't have the gumballs for my job, but I'm not gonna butter up Dough Nutt.

"You're not laying a ladyfinger on her," I grated. I was just boiling to mash his mouth, so to preserve him, I stalked off.

Cinn ran gingerly after me and caught my hand. "Don't dessert me now!"

She dissolved against me. Her soft peaks pressed against my chest. It was divinity.

My frosting was starting to melt. I needed to be set aside to marinate in some Nik-L-Nip and read all the labels again. So, I told Cinn to keep her candied lips closed.

We would mix later.

Back in the bread box, I felt stuck to the plate.  Who could be behind such a granulated mess?

I opened a bottle of Nik-L-Nip and wondered about Old Man Fudge Dropp.  I considered Nurse Coco Nutt with another bottle.  When I was drinking my third bottle I debated Kandi Korn.  A fourth bottle had me pondering Captain Dough Nutt.  My last bottle had me thinking about Sprinkles.

I fermented for a while.

"You smell like a whiskey sour," Cinn said tartly as she pinwheeled in.  I felt flat--like I had been made out of unsifted flour. 

"Get off your asparagus and get down to Placemat Place like minute rice!" she said hotly.

I had been flipped back onto the griddle like a wet pancake on a rubber spatula.

 In the early morning smell of coffee, Kandi Korn and Sprinkles were playing butterscotch.

Even though I was so pickled I could dill, I whisked down to Placemat Place.

Captain Dough Nutt had beaten me there. 

Dr. Sourpatch had been made into a side course.  His head had been bitten off; pastry was everywhere.  The kitchen counter looked like a Sunday casserole bake-off.

My topping churned.

Sprinkles was sprinkling.

"Get that decorated dog off my waxed paper!"  Captain Dough Nutt let off a few Skittles.

Kandi Korn was smoked.  She tossed a fizz bomb at Dough Nutt.

"Snack Size," Dough Nutt snarled.

"And YOU!"  Dough Nutt turned on Cinn Amon.  "You can't top me with a few honeyed words!  You'll be treated like every other cookie in the cookie jar!"

"Here's you a baker's dozen," I said, and I pied him right in the eye.

Cinn and I peeled out of there.  We dashed down the counter and pretzelled around the toaster to the spice rack. 

We folded in behind the cayenne pepper and the hot mustard.

It sure was hot there in the spice rack with Cinn pressed firmly against me.  I was going to need refrigerating overnight after this caper.

If Dough Nutt would quit devilling us, I could have savored the experience more fully.  But, instead, we had to crepe out of there.

I lifted Cinn down from the spice rack and she whispered she kneaded me.

"Show me your pad,"  she said.

I showed it to her.  With zest.

I believe that what happens behind cabinet doors stays behind cabinet doors.  But, I've tried a few cookie things in my timer, and Cinn takes the cake. 

I was done 35 minutes later.  Cinn was resting beside me on the hot pad. 

It felt like I had won potluck.

There wasn't time for seconds.  Kandi Korn and Sprinkles ran in, yelling that Nurse Coco Nutt had come under the knife.

I dashed to Cutting Board Corner.

Sure enough, Nurse Coco Nutt had checked her last oven temperature.  Her head and her marshmallow nurse's cap were gone.

I would miss the cap.

"We've been together since our mixing bowl days!"  Dough Nutt sobbed moistly.

"Sprinkles!  Sprinkles!  Here, boy!"  Kandi Korn was looking for her little frosted dog.

But Sprinkles was a hushed puppy.

As I walked through the steamy night, questions poured down like raisins from an Easter Bunny cake.  I sifted through them.

What kind of rotten egg would butcher a nurse?

Where was Sprinkles?

Why can't the kids ever remember to use Comet to scrub the stove?

But, some questions have no answers.

Rum Raisin is my secret ingredient.  Years ago, when we were just raw dough, we shared a saucepan a few times.  His inside recipes are good, and he gives good cooking tips.

Rum Raisin lives Under the Sink, where only self-rising types make it past the soft ball stage.

On my way to Garbage Disposal Parkway, I slid down the big dipper.  I kept an eye out for mousse. 

Under the Sink.  Words that evoke fear in every cream filling.  I squeezed among the cleaning products cautiously.   Smoke alarms aren't responded to down here.  I could be shredded, sliced or drained. 

I didn't want Dough Nutt to find me turned into spoonbread.

Rum Raisin stores the Berry brothers as his own personal protective wrap.   The Berry brothers are Black and Blue and both of them carry a toothpick.  And not the swizzle kind.   

No one in their family has ever been made into a pie.

They poked me for awhile to see if I was clean, then they ladled me into an unfamiliar place.  By the time they tossed me into the dishwasher, I was sure that I needed to get out pretty quiche.

But, there was Rum Raisin, tasty as ever. 

"Living in the dishwasher?" I said, checking to see if both my legs were broken.

"Man, my Man," he chuckled.  "I told you I was going clean."

Rum Raisin brought out a bottle of Nik-L-Nip, our old favorite.  We sat and talked, warming slowly.  I explained the hot sauce I was dipped in.

Rum Raisin felt that he was getting flaky.  "It's our limited shelf life, dammit.  Sorry--didn't mean to custard at you.  But,  Man, it is!  I'm gettin' out, headin' north."

"To freeze?"

"Yep, it's freezin'!  What's the choice?  We're gonna get chewed up here if we don't do somethin'!"

Black Berry ducked in.

"Uhhhh...Boss, Ms. Meringue to see ya."

"Meringue!"  Rum Raisin whipped to his feet.  "Gotta go, bro.  It's Meringue.  She likes to be on top."

I drifted past to Piecrust Park, thinking of everything that had changed.  Sourpatch was gone, Rum Raisin was leaving.

I was to find more to roux very soon.

Dough Nutt had come under the rolling pin.   He was spread across the counter like peanut butter on a peanut butter and jelly sandwich.

There had been a time that I would have done the Tupperware Bounce about Dough Nutt being flattened.  But right now, I wanted the culprit jelled.

There was something in the air; something that smelled more like devil's food than angel food.  I whipped out of there like cream in a blender.

And, there it was.  A broken candy cane.

And beside it, a piece of candy corn.

Right on thyme, Cinnamon Swirl appeared.  My favorite flavor.

"It was YOU!"  I said hotly.

"No!  No!"  Cinn protested meltingly.  "Don't pecan me like this!  I would never let you fall flat!"

She was nutty if she thought I would dissolve for that.  "You killed Dough Nutt!   And Fudge Dropp!"

Tears like molasses ran down her cheeks.  "I love you--"

"You're delicious, there's no doubt about it," I felt like I had been torn off an ungreased pan.  "But your story is wafer thin."

Just then, Cinn was grabbed from behind.  Apparently, she was late for the feast.

I didn't wait for carry out.  I ran like ganache on a warm cupcake.

I whipped past the sink and corkscrewed down a hand towel into the cutlery drawer.  It was the only way I could preserve my trimming.

When I glaze back now, I realize my romance with Cinn was semi-sweet.  I vowed to go on a diet.  No more snacks.

I set up a new office in the glass cupboard.  Everything seemed more transparent there; issues were clearer and drinking was easier than ever.


One evening, after a couple of bottles of Nik-L-Nip, the kitchen timer went off again.

"Mr. Man?"  Her voice was like spiced honey.  She was seven courses, every one of them made from scratch.  Her Fruit Roll Up dress was rolled 'way, 'way up.

"My name is Rhedd Hott."