Madness I Say

The air is cooler now, the last straggler leaves are hanging on in vain and the TV blares ads and Christmas jingles.  It must be Thanksgiving.  And what comes with Thanksgiving?

Black Friday!

Yes, that consumer smorgasbord of “deals” meant to strip us of hard-earned cash early in the season of giving.  Yes, long lines, maddening crowds, a little trampling here or there and stores opening the break of dawn (well, break of dawn in Europe maybe).  For weeks now we have been inundated with ads for “pre-Black Friday” and the real thing.  For some (I’m looking at you Target and Amazon) the first Black Friday sales were on the day after Halloween!  Pretty soon if this date creep continues the first Black Friday deals will be available on Boxing Day.

And what for?

Historically Black Friday marked the beginning of the Christmas shopping season.  As a child I can remember for Frederick and Nelson‘s, a department store in downtown Seattle would keep their windows covered up until that day.  When the blinds came down, we were greeted with magical vistas of Christmas gifts and scenes.  The stores themselves had not decorated until the night before.  There was no wreath hanging in the mall the first week of November.  It was that day that Santa took up residence in his corner at the store while hundreds of families braved the cold and wet weather for yearly pictures with him.   After that day it was OK to be Christmas.  As a kid it was that struggle to keep ourselves contained until the magical day now less than a month away.

As I got older it began to mean less and less.  When I worked for UPS, Black Friday was the start of “peak” season.  It meant more planes, more packages and more hours.  It also meant more stress on the workers.  Later on when I moved companies it meant more importers calling to see if their shipment was on the flight that just landed and when it would clear Customs.   While it was rare to see Christmas decorations before Thanksgiving, now it began earlier.  I cried when the first Christmas ad I heard was on the day after Halloween one year.

But what does it mean for industry?  Traditionally, the theory goes, it is the day that stores start showing a profit, or “being in the black”.  Thanks to creative accounting and reckless spending by the American public, nearly any day can do this now, but some still hold true.  But the sales data from Black Friday, and it’s cousin, Cyber Monday, are heralded with glee by news commentators as to the health of the spending public.  Moreso, it is a chance to offer slightly enticing deals to get shoppers into the stores. A $4 mixer?  Sure, I already have 2, but you never know when I’ll need another, plus it’s too good of a deal to pass up!  Brainless consumerism, buying stuff because it is a “good deal” is the sickness of the American consumer.

Not to say that I’m immune.  Each year I look at the ads and weight my options.  A couple of years ago, I was with my wife’s family in Northern Arizona for Thanksgiving.  Even in a small town, there was still Black Friday madness, I mean, there was JC Penny, and Fashion Bug and of course Walmart.  I had had my eye on a digital camera since my old one got lost on vacation earlier that year and Walmart had a deal.  I figured being a small town, things would no be so crazy.  Not.  I rolled down to the store early, like 5am early and the place was hopping.  Not trampling busy, but plenty of folks doing their thing.  Lucky for me I had the clarity of a mission.  Blinders firmly in place, I headed towards the Electronics section, skirting the scrum of people wrangling over $20 DVD players and wrestling over the last of the 3 cheap laptops in stock, I found my camera.  Grabbed it along with an extra battery and memory card and I was gone.  Through the check-out quickly thanks to cash and on my way.  Total time elapsed:  5 minutes.  Of course we went back later in the day for the late risers and it was crazier then than it had been at 5am.  And there was still a huge stack of the camera I bought earlier that morning.

This year, like the last 2 I will be on my way home when the shopping madness is in full swing having worked the night before.  My wife and our neighbor are going to brave the crowds for some stupid reason, but I’m staying at home this year.  So to all of you going out on Black Friday, good luck.  Be safe and be smart.

Insanity Virus?

Schizophrenia has long been blamed on bad genes or even bad parents. Wrong, says a growing group of psychiatrists. The real culprit, they claim, is a virus that lives entwined in every person’s DNA.

via The Insanity Virus | Mental Health | DISCOVER Magazine.

The deeper we get into genomics and sequencing of our own genome how many other “unwelcome” surprises might we finds?  Truly cutting edge and thinking outside of established norms.

h/t to @Geek2Nurse on Twitter

It’s Like It’s the End of the World.

Snow.

Nothing can bring such madness as this one simple word.  Even though it is just a threat of snow,  nothing on the ground and people act like it is the Blizzard to End ALL Blizzards.

Snow haunted me through nursing school.  No mater if there was 2 inches or a foot, I had to go.  Nothing says fun like a drive to school in a 1973 VW Bug at 6am when it is 24° out and windchill to 0° all while lugging my massive Med-Surg text, A&P book, plus the other assorted miscellany needed for a day of school out to the car while looking like Ralphie’s little brother due to the amount of clothes I was wearing.

There she is, the little red one with that light dusting of snow.  That little car got to everyone of my clinical dates (even the one I got pulled over before), to class everyday except the day I broke my key thanks to ice.  Nothing says fun like scraping the inside of a windshield so that I could see out.  Sure, I would have to sit there and warm it up for 30 minutes before even attempting to drive, but I drove in all sorts of nasty weather in Flagstaff.

It was never a question of going to school.  So I learned how to drive in the snow.  Learned how to pry my frozen fingers off the wheel when I got to school.  I learned how to carry the 60lbs books and other crap we were required to carry.  Nursing school taught me far more than the required information needed to become a nurse:  it taught me to deal with adversity.

It isn’t easy, just like nursing isn’t easy.  It breaks us down to build us back up.  Remember when you first stepped on a floor for clinicals?  You were freaked out, like our city in the face of a storm, but as the day went, you grew more comfortable, it grew easier and soon you found yourself thriving in the new and different environment.  Now when you step on the floor you know what needs to be done.  You know how it needs to be done.  That’s knowledge brought on by the act of nursing, the practice.  You are able to deal with the adversity that faces us everyday because you’ve been through it all.

Now I’m off to stock up on groceries, run around like crazy tracking down a heater and generally acting like an idiot – there’s snow coming!

Oooh. C.Diff!

Those that follow my Tweatstream saw this pic the other day.  It is the inside of a piece of colon removed from a patient with a fulminant C.Diff infection that was making them septic.  Those little yellow dots are the pseudomembranes that are the hallmark of pseudomembranous colitis. That and the excessive nasty diarrhea.

Yes Virginia, those are in your colon.

Someone posted this video clip on YouTube which shows the same thing, only when it is still inside.  Have we no shame?

This post brought to you thanks to a talk given by a surgeon who was speaking about nutraceuticals (antioxidants, probiotics and what have you) in the treatment of ICU patients.  Really interesting field of research with pretty spectacular outcomes when it comes to mortality, but leave it to a floor nurse to fixate on something dealing with poop!

It’s the Little Things

It is never the BIG things that will drive you mad, it is the little things, those continuous little irritating reminders that get under your skin that make work so damn frustrating.  It’s the little idiosyncrasies of some nurses practices that will drive you up a wall.  I’ve mentioned the “freak out over nothing” otherwise known as Chicken Little, but almost worse is the “I forgot the basics of nursing school.”

C’mon!  The basics, turns, intake/output, taking a temperature with vitals, all in all really easy simple things.  But it is like these don’t matter to a couple of my colleagues.  And lately it seems like I’ve gotten the shit for it.

Case #1:  obtunded patient.  On continuous IV fluids and a crap-load of IV meds.  Intake charted for entire shift:  nothing.  Nothing was charted.  According to the charting, they were incontinent 42 times.  OK, they’re basically hospice, but we have nothing official, shouldn’t we be doing the typical charting as if they were a regular patient?  Thanks for that, when the docs ask me if they had any intake at all during the day I look like the idiot.  Luckily I can point to my charting.  What gets me with this, is that it is the easiest thing to do on an obtunded patient.  If you can’t track accurate I&Os with them, how are you going to capture that on a mobile CHF patients – where it is really important?!

Case #2:  Afib patient, on an amiodarone drip.  Something doesn’t jive in the orders and when asked, they say,  “I don’t know, I’ve never hung amio, just followed what pharmacy wrote on the bag.”  First, I have to explain typical protocol is 1mg/min for 6 hours then a decreases to 0.5mg/min for 18 hours, standard loading protocol.  It’s not like I’m pulling it out of my ass, it’s from the book.  So what that the 1mg/min has be running for like 9 hours?  Second, why didn’t you look it up?  You admitted to me that you had never hung an amiodarone drip, we have a resource book that details floor protocol for initiation and maintenance, it’s all there, black and white.  Again, I get to call the docs, explain the situation and get new orders.  Truly it’s not a big deal, but it is the principle of it all.

If you can’t effectively manage simple situations, situations where you have available resources and ability to follow-up, how will you function when the shit hits the fan?  I now know most of the meds I give on a regular basis, but I get ones where I have no idea.  So what do I do?  Look ’em up.  It’s not like our patients are crashing and need them now, we have time to be thorough.  I&Os?  Yeah, on our basic patients I don’t always record.  But if they are getting fluids/meds/drips you’re damn sure that’s getting recorded.  I’m not perfect, never claimed to be.  I make bone-headed mistakes and overlook stuff.  Those are the exceptions though, not the normal.  I bitch about it because for some it is normal.  That’s the scary part.  When it happens I try to talk to them, but too often it gets left by the wayside, pushed aside and taken care of.

To me the leaving of the little things (these are just two recent examples – from multiple nurses), tells me that you’re either A.) not paying attention, or B.) don’t get it.  The little things are what differentiates the good nurses from the mediocre.  The little things are the keys to catching our patients before they crump.  The little things are what sets nurses apart and why techs can’t do our jobs.  And it’s the little things that piss you off the most.

Saturday Linky-Linky

I’ve been holed up on the couch or 2 days dealing with a rather nasty GI issue and all of my ideas are literally in the crapper.  In the fashion of bloggers everywhere, here’s a link post.  Enjoy!

Happy Halloween!  No really, enjoy the condoms given out as trick-or-treat items by one local family.  Of course you have the debate between the progressive and pragmatic givers (both of whom are doctors) in providing prophylactics to high-school age revelers – ’cause giving a teen condoms will make them sexually active – and the prudish small town head-in-sand folks who believe that they should be the ones to teach sex to their children (but never do…).

Got MRSANDM-1 E.coli?  Got some other nasty resistant bacteria that nothing in our arsenal will cure?  Good news, the federal government is looking at subsidies tot he pharmaceutical industry to promote research in to new antibiotics.  Of course, this isn’t going to happen quickly, so by the time we have full-blown VRSA and NDM-1 MRSA we might have something to throw at it.  Maybe.  And considering the shape and mentality of the government now, highly unlikely.

Can we make up our minds?  One moment it’s good for you, the next it increases your stroke risk.  And health care providers drink it by the gallon:  coffee.  New study shows increased risk of stroke for infrequent drinkers of the stuff. So I guess if you pound cups daily you’re OK?    h/t to Sean at My Strong Medicine for this one.

Some days life gets in the way of blogging.  Some weeks that goes on for awhile as the rest of life gets in the way.  It’s not that I’ve lost the passion for writing, life just gets in the way.  It’s all about the life cycle of a blog. I’m not on life support, just trucking (slowly) along.

Finally I’ve figured out where my next vacation will be:  my own private island (for a week). Now that I have the where, I need to the figure the when and how parts.  That’s the hard part.
Enjoy the weekend!  Off to make pancakes!

Who Cares if I’m Gay or Not?

Can We Stop the I’m-a-Male-Nurse-Who-Isn’t-Gay-Contrary-to-the-Stereotype Routine? « Those Emergency Blues.

Awesome piece!

It’s what I tell my patients:  I am a nurse.  My gender/sexual orientation/going to be a doctor, all of that bullshit means nothing.  I am a nurse.  A professional, educated and capable.  I am a nurse.  Just so happens to be that I’m a man.

And it doesn’t matter.  I am a nurse.