Who’s Your Daddie?

Summer is finally here.  What do I love about summer?  Besides beer, barbecue and sun?  Outdoor concerts.  Yup.  Nothing says summer like a big outdoor festival, or small show in the local park.

Yesterday I saw the Cherry Poppin Daddies (yes, Zoot Suit Riot) as part of a local parks and rec concert series.  It’s sad in a way to think that these guys who once rocked out on Letterman were reduced to the casino/parks & red circuit, but they still put on an awesome show.  It was odd to see them in a family friendly atmosphere considering the last time I saw them was in a small seedy club that was not family-friendly.  So in honor of the boys from Eugene (Oregon baby!), and the one dude skankin’ in the front row the whole show, I found some great live clips.

Here Comes the Snake.  Hmmm…friendly?  Maybe.

Don Quixote.

Irish Whiskey.  Yes I’ll have one and drink to departed friends.

The world though only knows them for swing.  And for one song.  It’s good.  It’s fun live.  But there is better in the catalog.  Who’s you daddie?  Yes.  I am.

Teach Them Well

Our floor sees a lot of nursing students.  All year long too.  No breaks for summer even.  I love it when they come arrive in the morning, fresh-faced and excited to be “in the hospital“.  I can remember that feeling as well, it wasn’t that long ago that I was one of them.  Relatively speaking.  I hate it too though, because part of me feels like I need to tame their enthusiasm, like their thirst for experience is a bad thing.  I find myself saying in my mind only half-jokingly “Run.  Run far away!”

But most of all I love it when I can present a small pearl of slightly jaded cynical nurse wisdom as I did the other morning.

One of them was asking about a patient assignment.  In a moment of cruelty I had sent her patient to another floor the previous night to make room for a patient that needed heart monitoring.  We were discussing who might be appropriate and I was running through the list of diagnoses on the floor.

“They have pneumonia, that’s a UTI, he’s FOS…”

She looked at me with a quizzical expression, “FOS?”

“Uh,” trying valiantly to find a PC way of putting it then just going for the truth, “Y’know, Full Of Shit.”  The last sotto voce.

“Oh.”  A disappointed look coming over her face.

“No, really,” I said quickly, “He has a colon full of stool, so he is literally full of s….”

Welcome to nursing.  We’re all FOS in one way or another.

Musical Saturday Morning

Tucked safely in the grasp of public transit for my commute this morning I was hit with an avalanche of great music thanks to the “shuffle” setting on my iPod.  Granted the last thing one needs after a night in the trenches is a refreshing blast of punk, metal, country and hip-hop blowing your ears off, but damn it was fun.  And I have to share the love.

Bad Brains, one of the all-time best hardcore punk bands.

Who doesn’t love the Beasties?  This is the track that re-ignited my love for the Beastie Boys way back in ’92.

A great song from a seminal grunge band, but Cash takes it and makes it his own in a version that is better than the original

There was local cover band playing at the Farmer’s Market this morning, but this version is better than theirs…

Surely Make You Lose Your Mind

Thanks to Ian over at impactED Nurse found a new and awesome blog:  Life in the Fast Lane.

Smart, well written and chock full of little interesting tidbits.  Or just some twisted trivia

  • At the end of the 19th century, hot irrigations with large volumes of saline were administered with Kemp’s double-current rectal tubes for what purpose?
  • For non-obstructive anuria… large hot irrigations, with normal salt solution, with Kemp’s doulbe-current rectal tubes, should be tried, as they are stated to stimulate the activity of the kidneys in a remarkable way.

Anyone who can dig up trivia related to rectal tubes in a winner in my book!

The Shakes

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By the time I got home the adrenaline was finally starting to wear off, the shakes trailing off.  I don’t really remember the drive, it was an automatic drive home.  I was aware, but detached as the images of what happened to my patient just minutes earlier kept running through my head.  Those images were accompanied by the snippets of conversation, the shock and fear, the cool, clammy sweat sticky back of my t-shirt as it clung to my back.  Numb, but not comfortably.

How quickly things can change with our patients.  One moment you’re waking up not feeling well, but OK, waiting for surgery, the next you’re vomiting up copious amount of blood and huge chunks of clots.  How strange it must be to not understand what happened because you went totally unresponsive right before you vomited.  Did you hear your nurse yell out in fear “Can I get some help in here?!  Someone call a Code!!!”

How odd it must be to open your eyes and see 15 people swarming your bed, frantic in their energy asking questions, asking you how you’re doing, sucking something out of your mouth.  Do you feel it when you vagal out, go asystolic, vomit more blood and have someone start pumping on your chest?  And when you ask, “Did I throw up?”  the the nurses tells you that you did, but all you can worry about is that you might have lost control of your bowels.  What goes through your mind when the nurse who has taken care of you for the last 2 nights is asking you to “Stay with me!”  Do you know when your blood pressure is 60 palp?  That you’re pale, diaphoretic and ashen?

Does riding in a bed moving like the furies are after it down the hall cause motion sickness?  I’m guessing that the worried looks, the terse simple descriptive language the nurses and docs are using, the speech of people under pressure must worry you.  Does your mind rebel at the unfairness of it all?  Did realizing you had stomach cancer make you mad?  You were a healthy guy.  Sure you drank, but you sobered up years ago.  Yeah, you smoked, but otherwise, healthy.  No chronic medical conditions, just some elevated lipids.  In fact your doc at your last yearly check-up said you were about the healthiest 80 year old he had seen in a long time.  Or is the only thing you’re thinking about is your wife of 50 some odd years and whether you’re going to see her again?

I know that when you got to the ICU you vomited more blood and clot chunks.  You looked incredibly pale, blood pressure barely registering.  There was blood all over the floor, all over you, all over the bed.  I wish you could see the cluster of docs outside your road, the 7 nurses around your bed, the cluster of medical knowledge all focused on saving you.  I wish I could tell you that it was going to be OK, that we’re going to take care of this, but deep down I know I can’t.  You’ve lost a lot of blood, it’s got to be close to 3 liters, blood and huge gelatinous chunks of clot, like something tore loose inside of you.  But you were in the best place and I was in the way.

It was the fastest 30 minutes I can remember in a long time.  The adrenaline was still surging as we brought the bed back upstairs but as I began talking to my colleagues the shakes started.  I knew they would, was waiting for them.  The shakes, the weakness in the knees, the self-doubt came crashing down, barely held back by an iron will.  It’s odd how I can remember bits and pieces, little flurries, but not a seamless narrative of the whole thing.  Maybe it’s a protective thing.  I remember the looks on my co-workers faces, the awe, the respect, the one who said, “I want you in my code, you were so in control.”  If they only knew.

If they knew that I spent the drive home going over every little bit of the previous 12 hours.  Could I have done anything differently?  Should I have checked your vitals at 4am instead of letting you sleep?  You had been rock-solid stable all day, all night, no sign that anything was amiss.  I know rationally that this was a quick thing, bright red blood spewing out is a rapid thing.  The clots?  Well the EGD pics were beyond nasty, huge masses of clot on the wall of the stomach.  It is like something broke open.  Still I wonder if there had been a sign early, if there was something I missed, or if it just came down to when you went unresponsive and started to vomit up blood.  You should know though, that I went home, and even though I’m not a religious guy, said a prayer for you, knowing you needed all the help you could get.

I just looked down at my hands, the shakes are gone.  Finally.