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Monday, June 14, 2010

Penn or Wilson?

In the mental health unit at the facility where my husband works as a nurse, one of the patients was complaining of rectal bleeding. After some investigation, one of the nurses learned that he had been using a tennis ball can as a dildo. She had to call the patient's attending, who wrote orders for a comparable sex toy and 1:1 observation by a staff member until a new, safe sex toy was procured.

My husband's coworker, Leanne, who is the manager for the unit, was somehow elected to buy the replacement dildo. She is notoriously polite and very slight in stature. All the staff members are harassing her to hurry up and buy something, so that they don't have to keep observing this guy. The patient threatens that the replacement dildo must be at least as wide and as long as his tennis ball can, or else he won't use it and will continue to insert random foreign objects up his butt.

All I can imagine is Leanne sheepishly bringing some huge dildo up to the register and trying to explain "really, this is for my job."

Sunday, June 13, 2010

SDCOD

Husband: Did you just fart?
Me: No.
Husband: What was that noise?
Me: I don't know.
Husband: You did fart, didn't you...
Me: Smell my butt; I did not fart.

Sunday, June 6, 2010

Sleep Deprived Comment of the Day

Inspired by the Medical RNinja and her cat of the day and Latin of the day series, I have decided to trial a sleep deprived comment of the day series (SDCOD, pronounced: sad cod).


So, here goes:


This morning, I walked into a patient's room to empty his Foley bag and noticed that his nasal cannula was way up on his forehead. I leaned over and said to him "I'm just going to readjust your Foley and put it in your nose, okay?"

Thursday, June 3, 2010

Instant Popularity

Last night I was floated to the emergency department. They were slammed with mental health patients and had something like five patients who required 1:1 observations, so of course I was perched on a stool, watching one of the patients, and waiting impatiently for each second, minute, and eventually hour to tick by. After being in the general calm of the ICU for all these weeks, I had forgotten the pleasing chaos of the ED: a very new baby crying, constantly chiming call bells, staff bustling back and forth, the obscene shouts of a combative drunk guy, and the eighties rock Dr. D likes to play on the radio.

A guy in a white coat walked past me and asked one of the techs where the commodes were kept. I thought he was a physician, but if he were looking for a commode then maybe I was mixed up.

I stopped one of the techs. "Jess, who is that guy?" I asked.
"That's Dr. Cho. He's awesome."

Twenty seconds later I saw him emerge from the storeroom, commode in hand, walking it into the patient room he had just come from. It seems like a sort of goofy, exaggerated reaction, but I was shocked. I have never, ever, in the three plus years that I've been employed in healthcare observed a physician get involved in toileting.

So, Dr. Cho, I agree with Jess. You must be awesome (as demonstrated by your crazy and unexpected act of awesomeness last night). I don't mean this in a political way, or that all doctors should start emptying bed pans. However, I do think that anyone who occasionally steps out the constraints of his or her job description to pitch in and help the team ends up building some significant camaraderie with the staff. I will remember this when I want to be awesome.

Tuesday, June 1, 2010

Too Busy

I walked through the doors into the ICU and set down my bag.

"You just missed it like five minutes ago," Kate said. "We were coding her for about an hour, and then they called it."

The deceased patient's nurse was standing nearby spewing a steady stream of frustration to the charge nurse.
"When she came in, she was doing fairly well. She was up and talking to her family. Not too long after they left, she started having a really hard time breathing -- at one point she even asked to be intubated. I called Dr. Rubenstein (who admitted her) two hours ago when she was in respiratory distress and told him that he needed to come and see her, that I was really concerned about her," she said, "but he told me that he was too busy, that the intensivist could see her. He never called later to follow up on how she was doing, so now, we need to call him and let him know that his patient is dead."

Dr. Rubenstein arrived a few minutes later.
"When we say we need you to come check on one of your patients, we really mean it," said the charge nurse.
"Okay. That's good to know. I feel badly about this." He replied awkwardly.

They continued to converse as I walked into her room to get her cleaned up for the family. Things are always a mess after a code. The floor and the bed are usually littered with empty medication boxes and wrappers. There are three or sometimes four triple-IV pumps, maybe a ventilator, the crash cart, and an ultrasound or EKG machine to name a few. It is amazing that the people performing the code can even fit in the room among all this equipment and the maze of wires and tubing.

Her eyes were half-open, fixed upon the wall. Her face was obscured by all our equipment: her mouth, lips concaved around her bare gums, hung open to accommodate her recently placed endotracheal (ET) tube, her forehead covered by a large 02 sensor, and her cheeks hidden by the ET tube holder.

I took off the sensor and the tube holder. I disconnected IVs and wheeled the extraneous equipment out of her room. I cleaned the blood off of her skin with a washcloth. It was time to get the family. I am thankful this job didn't fall on me - I knew almost nothing about the patient or the sequence of events that precluded her death. Her nurse went to the waiting room to get the family.

I sat at a the nursing station, printing EKG strips, trying to be busy, trying to avoid interaction. I didn't know what to say. A younger man and woman stood on either side of the woman's husband, physically supporting him, slowly walking him to her room. I have been sitting here trying to find words to describe this man's grief, but I don't think I'll ever accurately describe it: he was visibly broken. An otherwise dignified man, he sat beside her dead body, holding her limp hand, unable to contain his weak, wobbling cries, head in his hands. His wife, who was alive and talking to him a few hours ago, was suddenly gone forever.

I can't help but wonder if things would have been different if Dr. Rubenstein had showed up when he was called. I don't think the patient would have fared differently, though. The intensivist in the unit showed up right away, and so did the cardiologist on call. There were two physicians with her, both of whom were probably better prepared to take care of her than he was. Still, if I were in Dr. Rubenstein's situation, being too busy that afternoon would have weighed heavily on my conscience.