Spending your rebate?

I am so damn tired about everyone and their uncle telling me I should go out and spend my rebate.  “It will stimulate the economy!” is the refrain the journalists, and our commander-in-chief is telling us.  Personally, I would have liked it better if they had never taken the money in the first place, but that is a whole other ballgame.

I believe the American way to spend it would be on porn, guns and alcohol.  But I don’t have the time to defile myself in that manner.  That and it isn’t for me.  The alcohol? Yes.  But I can live without the others.  So I did some looking around, pulled out the calculator and opened a cold, frosty beverage and came up with some ways to spend your rebate.

So the rebate is based on a married family of 2 with no children, which is $1200.  Since I live in Portland, OR, average prices are either local or via Internet.  Some are anecdotal.  Remember, this is for fun…

To set one up, here’s a patient:  56y/o male, CHF, Diabetes, HTN, s/p placement of stents X2 to the RCA.  Med prices are based on 3 month supply ordered without insurance from drugstore.com.

Cost: $1468.99, or 122% of the rebate.

Lisinopril 10 mg QD: 31.99
Lasix 40mg QD: 46.63
Lipitor 40mg QD: 335.97
Norvasc 5mg QD: 105.97
Metoprolol 50mg BID: 26.95
Plavix 75mg QD: 389.96
Novolog 1 bottle: 261.54
Lantus 1 bottle: 256.18
ASA 325mg QD: 12.99

Doesn’t even get 3 months worth of meds.  Yes, I know, grandly exagerrated.

But what could be better than buying stock in the pharmaceutical industry? You could make a portfolio that looks like this:

6 of Merck $41.44/share
5 of Sanofi Aventis $78.35/share (converted from euros)
5 of Bayer Schering Pharma AG: $84.76/share (converted from euros)
7 of Pfizer $20.20/share

You’d be so money!

Or you could get 1 MRI (of the lower back), price before insurance.

80 GP Doctor visits, or 40 Specialist visits on my health plan.

171 Generic Prescriptions

66 Venipunctures, not to mention the cost of doing the labs.

You could get one of these:

A 2007 GT GTR Series 2 Road Bike from Performance for $1099 and still have a buck or two for cool gear.

Or you could get 2 of these:

Mongoose Sabrosa Single Speed Commuters, so you and the wife can ride to work and avoid blowing your rebate on 330 gallons of gas which is 25 fills of my car.

If you were really wild and crazy you could get 36% of a Gary Fisher Superfly, like this one:

Still you could buy a Trimet Monthly Pass for 15 months.

How about 8 dinners at Ruth Chris’s Steak House?

Better yet, 1.6 Ambulance rides due to either a heart attack from all the meat or from a cycling accident.

How about adding $260 for a birthday weekend in Las Vegas, including flights and 3 nights at Treasure Island?  You’re already in the hole and haven’t begun to gamble!

Instead of paying someone to fly, buy 346 gallons of jet fuel, just over 2900 lbs., which is not even enough to get a 737 to taxi.  That idea’s bunk.

How about a nice donation to the Joe Snow Memorial Fund?

Or give Nurse K a week off from triage.

Or help Ian (and others) support nursing students in Nigeria with Project N.

Or get something (like a mini jump kit) for EE, who’s expecting.

Or a cup of coffee and wifi for Kim.

Or a donation to Nurse Sean to help replace a sacrificial stethoscope.

Heck, I’d even take $15 to turn this into lostonthefloor.com…

Or we could spend it on something like 150 (not like I did the math or anything) six-packs of beer

Most of all, have fun with it.  And don’t buy anything from WalMart.

New JHACO Compliance Tool

A robot. The story is here.

The best line is, “He said: “i-Ward would mean hospital staff being able to spend more time with their patients, relieving them from the drudgery of mundane tasks.”  In other words, more time to spend completing JHACO mandated forms (in triplicate…).  Isn’t that real nusing?  Why do patient care when  you can be filling out multiple forms about your patient?

At least we’ll have a robot to wipe butts for us.  The real winner would be a robot that would actually take care of JHACO-related bullshit and let us be nurses, not secretaries.

Streaming Consciouness

This week has been a wash.

First was our annual skills day where we get to show we are competent to work in our unit.  Rhythm interpretation and needed interventions, 12-lead interpretation, use of a temporary external pacemaker and removal of arterial sheaths.  Plus the ever famous in-services where we get told that we’re “doin’ OK, but need to get better at documenting things.”  Also included was a blurb about National Patient Safety Goals that has the dreaded “anyone can call an RRT” verbiage in it.  A consensus was reached that we will put it in the patient guidebooks, but in point size 3 font and in UV ink so it can only be seen under a black light.  I can only imagine the chaos and carnage our frequent flyers will bring when they realize that they can do this.  I mean calling an RRT because the nurse is 5 minutes late with your pain meds is acceptable, right?  My comment of “so are there going to be consequences for repeat inappropriate offenders?” was met with laughs and the ugly realization that there wasn’t going to be.  Thank you so much JHACO Joint Commission, for another safety goal that sounds absolutely horrifying on paper and probably worse in reality.  Also found out that according to our RRT documentation, none of our RRTs in well, forever, have ever ended.  Funny thing that documentation.

Then mother-in-law houseguest left for a month to Norway; wife and I have not had the house to ourselves in 5 months..I don’t think we’ll know what to do.  Yeah right.  I remember.  I don’t think there will be much blogging…

Next was new grad interviews.  Nurse Manager asks staff nurses to be a part of the interview panel adn gives nearly unlimited power of decision over who gets an offer.  She trusts our judgment.  In her words, “You’re the ones that are going to have to work with them.”  It was very interesting.  The first time I helped out with this about 3 months ago, we had candidates show up in jeans.  Not fashion denim stuff, but work in the garage jeans, minus the grease stains.  They didn’t get an offer.  Like with any hiring situation, we had some good, some bad.  Some were possibly dangerous.  I said of one, “Day shift will eat them alive and frankly, I don’t want to have to carry them on nights.”  Cruel?  Maybe, but completely honest.

I end this week as charge.  I really, really hope my black cloud has dissipated. Judging from my deleterious effect on a quickly going south patient a week ago (to be blogged about soon, I swear!) it is still in effect.  Only time will tell…

Where’s the nose?

We have a frequent flyer that occasionally hits our floor.  He’s, well, unique.  By unique I mean bat-shit crazy.  Not one to mince words he told one nurse to, “Get the fuck out of my room!” The other unique thing about him is that he has no nose.  Gone.  No longer there.  Just a gaping void.  Why?  I have no idea, but I guess it was either excessive cocaine bingeing in the 80’s, an abscess of sorts or a complication of a cancer.

Last time he was in he left AMA with our tele box and leads.  One moment he was there, next gone like smoke in the wind.  We figured he probably sold the bow to some friendly fellows who thought it brought them messages from beyond.  He was back in, for what reason I don’t know.  The next time I returned he had left.

We were sitting at the nurse’s station when my friend M piped up, “Where did Mr. No-nose go?  Did he get d/c’d?”

Without missing a beat I said, “Naw, he left AMA.  He got tired of everyone coming up to him and,” I mime the action of stealing a nose like you do to kids, “I’ve got your nose!  I’ve got your nose!”

My charge mutters, “You’re gonna burn for that one.”  But it’s lost in the cacophony of laugher rising out of the station.  All were laughing, some were even crying, they were laughing so hard.

Inappropriate?  Yes, I admit it was.  But it was funny though.

Into the Mystic

For the sake of protection, we’ll call him Bill.  Bill was dying.  Bill’s family knew it.  The once vibrant, ox-like provider was laying in a hospital bed.  And not doing well.  The man who had endured everything from a impaling himself on a ladder as a volunteer fireman to being sprayed with boiling bleach in an industrial accident to living with a progressive neurological condition, an almost pseudo-Parkinsonian ailment, that sapped his strength and ability to do things for himself couldn’t even turn over.  It seemed like he could not endure much longer.  What had started as an altered mental status brought on by a raging UTI was turning him increasingly septic.  That was how I got him the first night.

The day nurse reported that she had fought with his o2 saturations all day, finally resorting to a non-rebreather mask, cranked up to 12lpm that was barely keeping his sats above 90%.  Not to mention he was tachypneic and febrile.  A little tachycardic, but his blood pressures were holding well.  But he had been basically unresponsive since about 1400.  She had watched him slide and felt like she hadn’t been able to do anything about it.

I pulled up his labs.  It didn’t look good.  BUN and creatinine were rising, LFTs were going up, urine output was OK, but his ABG sucked.  Acidotic, but he was trying to compensate.  What he really needed was a tube and a ventilator.  But as a DNR that was not in his future.  I saved Bill until last on my first rounds of the evening, just knowing I would be spending a little extra time.  Not so much with him, but with family.

His wife sat there at the bedside looking tired.  I introduced myself and explained what I was going to be doing for Bill that night.  She introduced herself as Betti, Bill’s wife of nearly 55 years, who had up until the last 6 months been his sole caregiver at home.  Now Bill was not a small gent.  Well over 6 foot, he would have hung off the bed if there wasn’t a foot board and well over 250lbs.  Betti was a small lady, but she had wrangled him everyday until his condition deteriorated to the point where he could no longer transfer himself.  The wear shown on her face, she had been through the wringer.  We talked as I went about taking vitals and getting stuff sorted to where I was comfortable.  I stopped thought and asked, “I know he is a DNR, but I wanted to make sure that was correct.  It is right?”  The last thing I wanted was to have people changing their minds in the middle of a situation.

She responded, “Oh yes, last thing Bill would have wanted was life with a tube down his throat.  And we all have talked about it.  The children are all agree, these are his wishes.”

We continued to talk, about the prognosis the docs had given her, the treatments we could do and the fact I was going to try to make him as comfortable as I could.  You could see the weight lift off of her shoulders, no longer having to do it all herself.  She told me how they had been sweethearts, no one had believed in them, yet here they were, together still.  She spent the night resting on a cot at his bedside.  I kept her supplied with snacks and hot chocolate and a friendly ear.  The running refrain though was, “Yeah, I’ve seen worse, but I’ve also seen far better go quicker than anyone thought.  The last thing I want to do is give false hope.  He’s one sick guy, but we’ll keep at it, OK?”

Through the night Bill didn’t get worse, but he didn’t get better.  He was still running temperatures in the 39C range and nothing would touch it,  Tylenol?  For about an hour.  Ice packs?  Nada.  I think we would have burned out an Arctic Sun machine with him.  All the time his respirations were running 35-40 a minute.  He was blowing off CO2, but the wear was telling.  Every now and then when I talked to Bill he would open his eyes briefly, almost as if to say he was still there, or that maybe he recognized my voice, or thought I was someone else.  I always let him know what was going on, even if he was out of it, he needed to know I felt.  And so it went that night.

I gave report and went home.  When I got back, things had not changed much.  But I felt something in me.  Call it the power of the spirit, or the guidance of a higher power, but I knew I needed to get Bill ready.  Betti, who had stayed all day decided to go home.  In fact I encouraged it.  I told her, “You need to take care of yourself too y’know.”  She nodded wanly, tired.  The weight had been put back on her over the course of the day.  A family friend offered to stay the night, to which I added, “Should anything change, we’ll call, ok?”

I felt helpless though.  There was nothing I could do to stop the inevitable.  I knew it, the inexorable slide had commenced.  No amount of antibiotics I could give would change it, no treatments, therapies or medical miracles could stop the process.  Bill and his family had made their choice.  In my head I commended them for their strength.  Too often, the resolve changes.  While a loved one sits at the door, they decide to throw the weight of modern medicine against Time.  Time always wins though.  But not Bill and his family.  They knew he wasn’t going to be here much longer.  While I couldn’t facilitate the “fixing” of him, I could give him every ounce of comfort I could.

Somewhere along the way I got bit by the bug to give Bill a bath and a shave.  I knew family would be there the next day and I wanted Bill to look good for them.  I can’t explain the why of it, just that I knew it was something I had to do.  Getting him ready for a trip.

So we did just that.  Got him cleaned up right good.  I even took the time to shave him, something I hadn’t done since school. He was fluffed and buffed, ready for the day.

As I left at the end of my shift, the friend pulled me aside and said to me, “Thanks for doing that, especially before his son got there last night.  I understand why Betti was glad you were here tonight.”

That made it all worth it.

Now, I kind of alluded to above, but I’m not particularly religious.  I believe in God and that mankind has an innate need to fulfill the expression of the spirit and that takes many forms.  But that night, I felt something.  Maybe it was the connection to the family.  Maybe it was the compassionate nurse in me.  Maybe it was born of exhaustion and doing what I did gave me a way to “neglect” my other patients for awhile.  I went home feeling better than I had in weeks.  I felt in some small way I had touched Bill and Betti’s lives and they knew it it and responded in kind.  Maybe it was something spiritual working through me.  I don’t know, but whatever the case was, I’m glad I got to experience it.

Bill departed on his trip later that morning, surrounded by his family, in peace. and comfort.

What you don’t want to see, part 3


This photo fills me with dread.  But I also look at it and go, “One day…one day.”

But 9 pumps?  Where does one draw the line?

Quick rant though…paging Dr. Dumbass again.  (Different one this time though.)

Do you think that instead of worrying about the stat MRI for leg weakness (at 2am in the morning), drawing some labs might have been a good thing?  Even after looking at the patient who just doesn’t look right and is barely conscious when we move him to the bed from the gurney?  I mean, a couple of hours until early AM labs doesn’t make that big of a difference for the day crew to handle his dispo.  Not to mention his WBCs were over 35,000, ammonia >130, LFTs thru the roof and BUN & Creatinine way out of whack when the labs were finally drawn.  I think the MRI was kind of a moot point with the patient in MODS and tubed in the Unit.  Don’t you?

The picture above reminded me of this.

Politics as Usual

I’m not a huge political guy.  You will not find me hunched over a copy of radical new liberal or neocon literature, of anything on this list.  But I do stay informed.  Or at least I try.  And since this is an election year it is nigh well impossible not to be at least a little informed and somewhat up to date on the various happenings.  I have been watching the campaigns, more for entertainment that anything of substance.

The other night I got a message on my phone inviting me to the Hillary Clinton rally happening this last weekend.  I was conflicted.  Should I stay or should I go?  Hillary fan I ain’t.  But the wife and I had said after Obama was here we should at least make the attempt to see the candidates.  I mean when else do you get to see American history live and in the flesh?  Based on that we decided to go. This was not out of a rabid desire to support anyone; it was out of curiosity.   And it was close.

We get there far too early on a Saturday morning. I mean 8am on a weekend is just wrong.  I should be sleeping I grumbled as we stood in the cold Oregon spring weather.  They gray skies matched my mood, which got even worse as I saw the line.  Here’s a picture to see at least what I could capture of it.

The line of liberals.

There’s a NOFX song, “The Longest Line” that says, “At the end of the longest line, that’s where were I will always be.”  Yeah, me too.  This line stretched behind me, around the perimeter of the parking lot ten in front of me around the building.  All waiting to see Hillary.  I made a valiant effort not to making “mooooo” or “baaaaaa” noises. The wife would have slapped me if I did, and I’m not a fan of public violence.  Anyways, off around the building and we had these wonderful guys.

Yep, the truth...it was the gummint.

As we got closer there were more “protesters.”   The truth was that it was cold and early.  And George Bush set-up the 9/11 attacks.  Really?  have you seen this guy?  Ok.  Then people selling everything from the classic campaign buttons (although none quite as nice as the “I Like Ike” buttons of yesteryear) to beanies and T-Shirts.  We thought of sending a T-Shirt to my wife’s step-father, a rabid Republican, but figured it would have been a waste of money.

I dig these guys though.  You have to admire those who are trying to free their country…

That and they had a tidbit of knowledge that I didn’t know.

ANA For Hillary

I didn’t know we (as in nurses) we supposed to supporting Hillary.  News to me.

So we got inside and it was standing-room only in the gym. And no room for the relative late-comers.  It was a full 45 minutes until she was even supposed to arrive and the place was packed.  With the rest of the groundlings we hung out in the overflow area to watch her projected on a screen. Just like on TV.  I thought, “If I knew I would be here seeing her on TV, I could have stayed home and done this in comfort.”

Then she arrived. Big cheers.  Flag waving.  Chanting of “Hillary!  Hillary!”  Enthusiastic accolades from Governor Kulongoski and Representative Hooley all leading up to the main event.  The candidate herself.  So here’s how it went.

Wow!  Great to be here in Hillsboro!  Let’s see if they can hear you in Portland!  (cheers)

The Bush administration sucks, blah, blah, blah.  (cheers)
Universal Health Care, blah, blah, blah.  (cheers)
Green Energy, blah, blah, blah.  (cheers)
Tax the rich and oil companies, blah, blah, blah.  (cheers)
Dick Cheney.  (boos)
I will get us out of Iraq, blah, blah, blah. (cheers)
Middle class rules, blah, blah, blah.  (cheers)
I have actual plans.  See them on my blah, blah, blah.  (cheers)
I’m going to keep fighting cause some old guy in California told me to, blah, blah, blah.  (cheers)
Jobs, blah, blah, blah.  (cheers)
Energy independence, blah, blah, blah.  (cheers)
Education, blah, blah, blah.  (cheers)
LNG Pipelines, blah, blah, blah.  (cheers)
Let’s open this up to questions.

At this point we decided to leave.  We could hardly see and it was the same canned speech that we expected to hear anyway.  What’s funny is that later that afternoon, on CNN, we caught her appearance in Eugene and heard the same speech nearly verbatim.

I won’t say she made some interesting points, she did.  I think many of her ideas rest on the basis of the average American making drastic changes and simply put, it ain’t going to happen.  I do not believe that the average American has the intestinal fortitude necessary to ride out the change to Universal Health Care, nor adapt to a green economy that she is preaching.  And there is no way that the oil companies are going to get behind reducing oil imports by 2/3, even if incentives are given for clean energy.  The liberal side of me likes many of the ideas, but that side got bitch-slapped my the realist side.  The reality is that these grand drastic changes will effect the very fiber and soul of our country and will be fought tooth and nail every step of the way.  That’s not to say that they will try to ram this down our throats and things will get stalled long and hard in the halls of Congress and it will be politics and business as usual, no matter who is sitting at 1600 Pennsylvania Avenue.

Cynical?  Yes.  That is me.  But it was fun to go.  I think that we will try to go see the other two candidates should they come to Oregon.  It would be fun.  And speaking of fun, I will leave y’all with this.  Enjoy!

The Curse of #66. Broken?

Most of my coworkers have a room that is their bane. Bad things have happened to them in their particular room. Some have had explosive diarrhea expelled onto them, others have had geysering arterial sprays from femoral artery closures gone bad, others have had deaths, codes and all manner of bad things. I learned early on my room of note was #66. I’ve had three folks crash in that room. One was a hypotensive event necessitating dopamine and dobutamine. It was the first time I ever saw pressures of 60s/30s. I didn’t like it. That was mere months off orientation. From that point on, that room just bedeviled me. There was hope though: it was only one particular charge nurse. When other charge nurses assigned me that room things were hunky-dory. But not J. When she gave me that room invariably the shit would hit the fan at some point in the night.

The first was the very first time I ever shipped someone to the ICU, which is recounted here: The Curse of #66 (or how to ship someone to the Unit). The second time earned itself a post as well in: A Revisit to Room #66. Lucky for me, it has been awhile since I’ve had that room. Until the other night.

It was about 2230. Things were going well.  Unfortunately, J was charge.  We were sitting at the nurse’s station, charting, chatting, generally having a good time, even flagrantly violating Joint Commission mandates on food in patient care areas when the realization hit me.  I asked her in an almost horrified tone, “Do you realize which room you gave me?”

“No” she replied.  She looked over at the board.  Her face dropped.  The smile left.  “I gave you 66 didn’t I?” she said in a near whisper.  She shot me a look that said, “Oh shit.”

“Yes.  Yes, you did.”  I replied.

“Well maybe it’s time to break the curse right?  I mean, you broke your streak of not getting a line last night, maybe tonight we’ll break another streak tonight.”  she responded with.   “It is a new year, right?” she continued.

“I hope so.” I said.  “We’ll see, but so far so good.” as I rapped my knuckles in the closest piece of wood.

The patient in question was going for open heart in the morning, so the potential was there.  I kept a watchful vigil through the night, but no more than normal.  I didn’t want the fickle nursing gods to turn their spite on me.  A little later as I’m helping out another nurse with an unresponsive patient (who needs a decent blood sugar, 48mg/dl is good right?), I hear the clarion call overhead, “Rapid Response Team to Wanderer’s Floor!”

“Oh crap” I thought as I poked my head outside the room, “who’s going down?”

“Next door!”  one of the nurses said as she went whipping by with a vitals cart.  A small dribble relief went down my spine.  Bullet dodged.

Sooner than later though 0700 dawned.  Nothing.  My patient was ready for surgery. Family was expectantly waiting for surgery to take her down to the OR.  I said my good bye, wished her luck and told her I would see her afterwards when she came back to the floor, then I turned and walked off the floor.

The curse was broken.  At least for now…