Today Was a Good Day

Open road, sunny blue skies, two wheels just spinning.

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New Ways to Classify Urine

Clear.

Yellow.

Frothy.

Red-tinged.

All so boring.  So trite and normal.  There has got to be a better, more descriptive way to classify it.  Hmmm…

How about beer?  Stay with me here.

Cloudy, amber with a slightly frothy head.  Could be a nice IPA or a patient with high bilirubin.  Am I right?  I live in a town that prides itself on its beer.  Hell, we call it “Beervana” and has the most breweries per capita.  We can call it the Portland Urine Scale, or “the P.U.S.”

You have:

Pilsner.  Clear, yellow.

Blonde Ale.  Cloudy.

Lager.  Concentrated, still clear.

IPA.  Amber, hazy.

Stout.  WTF?!

It’s not a perfect system, but it makes giving report more fun.  “Yeah, I’d say it was like a light IPA, not too amber, hazy and it smelled strong.”  Engaging, creative and descriptive, what a great way to share information?

 

Breakin’ Them In

I work in a teaching facility and thus hate July.  Why?  New Residents.  They come in with high expectations, flashing the white coat like a badge and think they will fix everyone, be loved by all the staff and generally kick ass.

The reality is a little different.

I know they mean well.  For too long they were cloistered in the halls of academia and they had some exposures to Real Medicine©, now it’s for real.  The nurses put up with the inane orders like “bladder ultrasound per nursing qshift, straight cath for >300ml” in a patient with no history or issues with urination, with a chuckle and a knowing glance.  We can tell when they get in-serviced on a new test/disease/condition/medication because all of a sudden they order it for every patient.  You can tell when they get the C.Diff lecture as all of a sudden everyone who has a trickle of diarrhea is a “rule-out C.Diff“, even when said diarrhea is caused by stacked doses of Miralax, colace, senna, milk of mag and a Theravac enema since they haven’t pooped in 5 days.  But it is when they come face-to-face with what nursing deals with 24-7 and their eyes go wide and they ask, “Really?  You guys do this?” it is almost priceless.  Case from last week is brilliant in it’s “Welcome to Medicine” slap-in-the-face reality check.

At midnight the patient was alert, oriented and cooperative and now at 4am they are claiming we’ve taken them from the hospital as they pissed all over the floor and nearly ripped out the IV line.  We can’t even talk to them as every time one of us walks in the room they yell “Get the Hell out of here!” and refuse any intervention or attempt at re-orientation.  Hard to re-adjust someone when they won’t even let you be in the room.  So we call the intern.  “I’ll be up to see them in a couple of minutes.”

When she goes in to talk with the patient, she pretty much gets the same treatment.  Maybe a little nicer and at least they are willing to answer her questions.  But pretty much it boils down to “get the Hell out!”

“I have to talk to my senior, but I think I’m going to give her something to calm her down.” she announces.

“I think that’s a great idea.” says the nurse.

After a conversation with her senior she says, “How fast can you get Haldol?

“It’s not on over-ride, but pharmacy is pretty good at getting it in for us, they know we don’t order it unless we need it.”  the nurse replies.

“So I’m going to give her 0.5mg…do you think IM or IV?”

“Y’know,” says the nurse, “I’m not sure I want to be around someone who doesn’t want me there with a sharps, not really into running the risk of getting stuck.’

“Oh yeah, I didn’t think of that.” says the resident.

As she fills in her senior who has just come up I look over at the nurse, “0.5?  Really? Maybe we should just wave the vial under her nose for all the good it will do, right?”

“I didn’t want to question her like that though,” said the nurse, “Don’t think she would really take it as the constructive criticism that it is…”  She then goes off to pull the Haldol from Pyxis.

The patient is staying in their room, but refusing everything and is sitting there with a slightly pissed off expression, but you get that gnawing feeling in the pit of your stomach looking at them, that at any moment they might explode and take a couple of us with.  It’s the calm before the storm feeling where you make sure there is nothing between you and the door.

So the nurse comes back with the Haldol and the resident asks, “So if she won’t let you even in the room, how are you going to give it to her?

“Unfortunately, we’re going to have to hold them so we can.”  the nurse replied.

“Like hold them down?”  slightly incredulous resident.

“Yeah, sometimes we have to do things patients don’t like for their own good.  It’s not the best thing, but sometimes we have to.”

“OK.  Can I come in with you, y’know, help?”  she says.

“Sure, the more the better.”

They head to the room, three of them, the senior and I stand just outside the room in case we’re needed.  “We have to give you some medication,” says the nurse  “Go ahead and hold the arm,” softly she says to the resident.  The resident lightly places her hands on the forearm.

“No, you’ll need to hold a little tighter, especially if she comes up swinging, I’ll dodge  but you might be so lucky.”

Arm down, the patient is screaming a blue streak at them, “Get the fuck out!  Leave me alone you fuckers!” but they get the med in and step out.

“Thanks,” the resident says, “I’ve never had to do that before…don’t always realize what you guys have to do.  Now we need to figure why they’re acting this way,” she finishes as they walk off the floor.

And the 0.5mg?  Didn’t do a damn thing.  At least the resident got a little eye-opener out of it.

Disclaimer…we don’t randomly go giving anti-psychotics to everyone, there’s a bunch of important relevant details left out, but you get the gist of it.

Night Shift Blues

The worst shift I ever worked was a 3-7:30 shift loading freight onto planes in Portland. Wet, windy, cold on the damp days, hot and windy when it was warm, and I had to walk uphill both ways to work. But at least there was time to deal with normal life that working night shift doesn’t give me.

My manager remarked to me that night-shifters tend to, “have a bit of chip on our shoulders, almost like the world owes you something.” Damn right I do. I’m up when most sane and rational people are asleep. I sleep when the rest of the world is doing there thing. If someone is loud, obnoxious when day shift sleeps, they can call the cops. Me? I’m outta luck.

So yes, I have a chip about it. The world wants 24-7 care, a 24-7 society, but does little to accommodate it. One of these needs has to give. Soon.

Under My Skin

It’s not often that I get riled up by things patients do thanks to a dedicated sense of Zen and a well-developed ability to shrug things off. So it’s a big deal to me when I let someone get to me.

Someone did the other night. I know rationally it’s not a big thing, in fact it happens fairly regularly. But deep in my psyche it stung and I’ve been perservating over it since. I got fired by a patient.

It’s happened before, it will happen again is what I keep telling myself, but it nevertheless unnerved me. Why? The reason? It was because I’m a man. Or as I crassly put it on Twitter, “I got fired because I have a penis.” It’s one of those things us men in nursing come up against and we have learned to take it in stride. There are ingrained social and societal mores, stereotypes and prejudices that cannot be erased in the first five minutes of you meeting me, the male nurse.

Rationally I get it. Emotionally/psychologically I don’t.

If you’re a 80-something year old lady, having a male nurse is probably a bit out of your comfort zone and no matter how professional the nurse is, it still isn’t comfortable. But I don’t understand totally. If you’re that age, odds are good, like 100%, that your Ob/Gyn was a man. You let them view and examine your holiest-of-holies, but when it comes to the nurse, the one who ensures you get the right medications, that the treatments we are doing is actually working,  it’s just too weird. I’m not asking to examine your bits, in fact I want nothing to do with them.  I even offered that if you were uncomfortable I could have our aide help you with your bathroom needs. Clueless I’m not. I can tell when things are not quite right and take preventative action, so I thought I had it covered.

Yeah, I was a little surprised when a family member came out to the nurses station and spoke to a co-worker about it. Not to mention I was sitting right there. My name was on the patient’s board and I was the only guy sitting there. They didn’t talk to me because they were ashamed, but here’s the thing: I wouldn’t have been so upset if they had asked me about it. In fact in I would have offered to swap assignments on the spot, no muss, no fuss, no dirt off my shoulder.

We swapped out assignments and solved the problem

Here’s the thing too, they commented to the nurse who replaced me that it wasn’t my ability, but merely my gender as the reason to swap.  I’ll take that.  More though, I was angry.  I was angry because it wasn’t my skills, my attitude or inter-personal skills, it was that I was a man.  It’s accepted because of this, but what if it had been because I was black, or gay, or Muslim?  I’m not truly making comparisons and saying I’m being oppressed, I’m trying to make a point.  Prejudice is still prejudice.

I will agree that there are some places men shouldn’t be nurses.  Hell, I’m guilty about it since I had a little bit of problem with my wife having a guy nurse in OB, but I never would have asked to change (and in that case only because he was incompetent.)

I had thought at this point in time the acceptance of men in nursing this was a non-issue.

I was wrong.

As I said above, it’s happened before and will happen again. But it still doesn’t make it right.

 

Addendum:  I’ve let this post simmer for awhile and while I’m not as pissed as I was, it still irks me.  But I tell myself, “get over it.”  And it works.  Most of the time.