You want what?

“Hi, Dr. Heart, I’m calling you about Mr. I’ve-gone-crazy who your partner did a pacer generator change on today.  He’s become very agitated and combative since the start of our shift.  I need something now to calm him down as nothing else has worked.  Would something like Depakote sprinkles or Zyprexa, maybe even Haldol be OK with you?  said the nurse into the phone.

Seriously, the guy was freaking out.  Every non-pharmacological method we have in the arsenal had been thrown at him.  He was confused and rightfully so.  It’s not nice to put folks with dementia through surgery, it leads to some very funky things.  He went from perseverating over his pants to perseverating over his wheel chair, then he wanted to be in bed, now in the chair and wherever you put him he wanted out of it.  Did I mention he could not stand and bear his own weight?

The other nurses looked at me imploringly to help his nurse out.  “You’ve got to do something!” they said to me.

“She’s his nurse, and yes, we’re doing all of her work for her, but I cannot call the doc for her.  I don’t know the details, I don’t know enough about his history to state my case for what I think is needed.  But I will talk with her.” I said.

The nurse came up to me minutes later and asked what to do.  I reeled off the things that might help, meds that we have used time and time again in these situations.  She agreed and went to call the doc.  Above is how I pictured the conversation (she likes to hide in the med room or pharmacy office to call).

I can surmise how the rest of the above conversation went.  “You want what?  I have no idea about any of those meds.  He’s agitated?  Um, not really used to dealing with this, is he covered by Medicine?  No?  Really?  I don’t even know what the doses would be for those meds in this situation.  Uhhh…how about some Ativan?”

To which the nurse readily agreed.  Really we would have taken anything at that point.  This is not to say that our cardiologists don’t know what they are doing, they’re just not as adept at helping us handle the agitated and combative elder as say our medicine interns or geriatrics service.  It’s a level of comfort.  Our geri docs would readily agree to something like Depakote far faster than Ativan, but it’s their milieu.  Would not want one of them dropping a stent in my patient.  It’s what you know.

And the Ativan?  It worked for a while but he ended up with a sitter by daybreak, still confused and combative, but staying safely in bed.  Lesson?  Avoid general anesthesia and things like Versed and Fentanyl on demented elders:  it makes them worse.

(Am not saying to not do procedures on folks of advanced age, make sure you give us the tools to manage them and ensure their safety post-operatively when you do!)

Dirty Old Man

or,  “How I will be when I’m old and demented.”

They say with age and dementia, decorum goes out the window and we revert to our true selves.  Or at least to our basest desires.  It doesn’t help however when we egg you on.

“Oh my God!” breathlessly says the nurse as she comes out of the room in a rush to grab something from the clean utility room.  “He’s a perv!”

About ten minutes later I learn why as our aide comes out of the room laughing and tells us why.

“So he has ‘sweet’ and ‘sour’ tattooed above each nipple, that’s a new one even for me!  As we’re cleaning him up I say, ‘Oh, and this is full of piss and vinegar, right?’ pointing to his peri area.   As I’m saying this he reaches over and caresses and pats my ass saying, “You better believe it baby!”  I almost died trying to keep a straight face!”

Passed it off to the next charge nurse that he was a little, “grabby.”

Fun with Electronic Charting, part 2

Found some more bloopers that made me laugh, hope they do you as well.  Here is the first post on the subject.

First up…

Patient tolerating poi well.

I don’t know, that stuff looks petty dodgy, they must be feeling better if they can tolerate it!

Admission diagnosis:  sincopy.

While they probably meant syncope (fancypants for “fainting”), they might be having bigger issues depending on whom’s sins they are copying.

In a progress note:

D/C Meth!

No explanation needed here.  Wish they would have written it as an order though.

My personal favorite of late:

Bladder non-distended, uterus not identified…  …right pelvic cyst, question ovarian.

Patient was a male.  I hope you weren’t able to find a uterus and I can guarantee the cyst is not ovarian.

That’s all for this round.  Enjoy!


Lost on the Floor: IN 3D!

The last part of that should have been in a booming thunderous announcer voice…but anyway.

My wife and I went to the movies yesterday, figuring it would be more entertaining than the Super Bowl.  We were only half right.  For the most part we’ve stayed away from 3D movies as there hasn’t been a compelling reason to do so.  That said, the movie we saw was not a compelling reason to view in 3D, but merely an opportunity.  Choosing The Green Hornet was a mixed blessing, but indicative of the issues inherent with 3D.  Reviews noted that the director really tried to embrace and make use of the medium beyond the classic “things flying at you” experience.  To that end it worked, unfortunately it really was the only thing that kind of worked in this mess of a movie.

This however, is not an indictment of the movie, but the medium.  To me, 3D is another gimmick that needs to run its course.  It can be fun, but Hollywood is relying on the gimmick rather than good stories.  Why write actual good engaging stories when you can drop a sub-par plot into 3D when people will flock just for the novelty?  Since the predominant trend in movie making is either a.) sequel/prequel relying on already established canon or b.) comic books adaptions (again with established canon) or c.) limply written unfunny (romantic) comedies relying on former top-billed actors a good plot is more of an after-thought, after the special effects, next to catering.  In this light the decisions to make a movie, plot no longer has a place.  What has taken its place is cross-marketing, tie-ins, toys, video games and ability to get people in the doors.  Inception, possibly my favorite recent movie was almost never released as it was “too smart” for the American public.  Wrong.  Some maybe, but not all, just look at the numbers.

There are the exceptions of late, The King’s Speech, The Social Network, but by and large we’re being inundated by movies that are pandering to our basest desires and minute attention spans.  And 3D is another way of doing it, a way of visually over-loading us to blur the lines and suspend rational thought.  Beyond this, my other issue is the tech itself.  I came away with an odd sense of nausea, my eyes hurt and had difficulty focusing well for about 10 minutes after and a slight headache. Plus the issues of wearing 2 pair of glasses (I looked very cool though…)  as I wear glasses and not contacts.  Not what I want every time I go to the moves.  Not to mention the cost ($11.25 for a matinee?  C’mon.).  I love movies.  I love watching them on the big screen and I hate to see my beloved medium ruined by stagnation and the death of true creativity.

Like before, this fad will hopefully run its course, like other fads in movies have (anyone remember Smell-o-vision?) and we’ll get back to the true telling of stories that is the heart of this art.  I have high hopes, but I temper those with the reality that the new filmmakers of this generation are the ones raised on the quick-bite fast-food style of story-telling that is so prevalent today.  Maybe I’ll be wrong.  One can only hope.