August, 2005 Archive

August 25, 2005, 1:12 pm

And the Darkest Hours Are Just Before Dawn…


Oh, my….Google put ads for Vioxx lawyers on the site… not exactly a match with my editorial opinions!

I’m finally getting my cape.

And a cap!

With an itty-bitty uniform and teeny-tiny white open-toed pumps.

I happened to pass by eBay and there were a TON of Barbie nursing outfits (circa 1961) just waiting for a bid.

I didn’t bid, though. I’m smarter than that.

I went right for “Buy It Now!”.

The outfit comes with black-rimmed glasses, presumably because nurses can’t look too glamourous. But Barbie has her pedicure showing with the open toes shoes, and pumps no less.

I have wanted this outfit for approximately 40 years; it’s costing me the equivalent of four real uniforms.

What would we do without eBay?


There is a virtual bus stop in front of every emergency room and it disgorges its charges at regular intervals.

It runs 24 hours a day.

You can set your watch by its arrival and tell the time by the patients seeking care.

Here is what the night shift might receive….

1:00 am: The Earache Hour

What is it about the nighttime that brings out the worst in ear pain? Kids that were fine at home suddenly wake up screaming in pain. Very disconcerting to the parents, but fortunately easy to treat.

2:00 am: The Croup Hour

Sleepy parents and kids sounding like the seal enclosure at Marine World comprise this block of patients. Usually the child sounds better by the time he gets to the ER. That’s an ER rule, by the way. “All symptoms in children cease upon entering the ER .” Diarrhea since birth, four years ago? Not now. Total lethargy for three weeks? Now the kid needs medication for attention deficit disorder. Acute abdominal pain since breakfast? The kid picks the “smiley face” on the pain scale. The parents are aghast and then embarrasssed for “overreacting” but the staff believes every word. Those of us with kids have been there.

3:00 am: The Alcohol-Induced Head Injury Hour

Brisk bleeding head lacerations attached to intoxicated patients are the hallmark of this hour. They probably fell, they may have been whacked, but every head-injured drunk is a subdural hematoma until proven otherwise; the CT scanner is very busy. The ER rule for this hour is “Nice when drunk, mean when sober.” These patients will urinate half a liter for every ounce of alcohol consumed, while asleep (that’s before they recieve hydration in the department). The problem, as a nurse would put it IF nursing diagnoses were used in real life, “Alteration in level of consciousness secondary to alcohol consumption resulting in alteration in urine output leading to incontinence.” Translation: have a lot of clean linen handy.

4 – 5:30 am: The Wee Hours

Patients are usually few and far between during these hours so the ER nurses study their procedure manuals, work on their certifications and read every nursing journal they can. (That was for the benefit of my manager.) We actually read, crochet, knit, listen to the radio, have that fresh cup of coffee, surf the internet and I have been known to practice my “moonwalking” dance moves (don’t laugh – it’s taken me 22 years to get it right).

By the way, NEVER, EVER, EVER say the word “quiet” when in the emergency room. It’s like dropping the “F-bomb” in church. I just isn’t done. Utter the “Q” word and you will ensure an avalanche of patients the numbers of which have never been seen in this lifetime. The bus driver will have to apply for overtime. The nurses will recoil from you. The doctor will rue the day you were born. Save your breath… yourself!

5:30 am: The It’s-Hip-To-Be-Square Hour

Somewhere, someone over the age of 75 is getting up to go to the bathroom and tripping over an area rug. Their hip will take the brunt of the fall and they will join the legions of people with titanium hips. They are scared and in excruciating pain so the “hover mat” is placed on the gurney before they arrive. It’s like floating on a cushion of air and makes transfering from the gurney in xray virtually painless. That, generous medication and the reassurance that a broken hip can be repaired help immensely. Now it’s time to wake up the orthopedist on call. Heck, for that matter it’s time to wake up the ER doctor…..

6:00 am: The Code Hour

Before this hour is over, a patient will arrive Code 3 with severe respiratory distress. Their EKG will be abnormal, their lungs full of fluid, their pasty skin drenched with sweat and the proverbial “elephant” on their chest. The emergency staff will hit that patient with every weapon in their arsenal of life until the patient is stabilized; lungs cleared, breathing restored, blood pressure maintained. The patient goes to the ICU. The staff gets ready to go home, only it will take just a little longer to fall asleep; it takes a while for the adrenalin to subside.

7:00 am: Hey-la, Hey-la, The Day Shift’s Back!

And because I don’t work days, I don’t know their story. I’ll interview a few and see what their day is like and report back from the “frontlines”.

But the PM shift…….now THAT is a whole ‘nother story…..

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August 20, 2005, 1:55 am

When Logic And Proportion Have Fallen Sloppy Dead….The Vioxx Verdict

Forgive a quick detour from the world of the emergency department. We all know elderly folks who carry a full page, single-spaced computerized list of their medications in their wallet. I’ll never be one of them because there won’t be any drugs. Listening to Hugh Hewitt discuss the Vioxx verdict today cemented my belief that sanity has, indeed, left the jury system

The plaintiff’s win is our collective loss. By awarding one-quarter billion dollars in damages, the Vioxx jury ensured more than the plaintiff’s financial security. They’ve contributed to the increase in drug-related lawsuits that are sure to follow as personal injury firms assess the financial incentive of similar cases. They have helped smother the incentive of research and development departments to develop new medications because of increasing financial vulnerability.

Merck lost the case, but we are the ones who will pay. When you receive your next prescription and you are paying a day’s wage for a two-week supply, remember this verdict. When you are suffering from a health problem and are unable choose a medication pulled off the market because it became too expensive to litigate, remember this verdict. When you are given a diagnosis for which no treatment is available because there has been no research in that area, remember this verdict.

The obscene amount awarded in the recent case against Merck is another nail in the drug companies’ coffin of liability. Until we legislate some form of protection against these unbelievable awards, the personal injury law firms will keep circling drug companies like vultures over an incapacitated animal.

“Remember what the Dormouse said….
Feed your head…….”

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August 15, 2005, 10:48 pm


cherryamesseniornurseTruth be told, I became a nurse so that I could wear THE CAP!

Oh, how I wanted that cap.

I would make one out of paper and pin it to my head, posing in front of the bathroom mirror with a towel around my shoulders for my cape.

I never did have a cape, but I definitely wore that little piece of starched white fabric. Our caps had green and gold ribbons arching across the top. I may have been your average Jane, but I felt like Miss America when it was on my head.


Of course, I graduated in 1978 (at the ripe old age of 20!), and with the expansion of nursing care came the end of the cap-wearing tradition.

I wore mine for about 6 months. Years of nursing fantasies, based in the 1940s world of Cherry Ames, were quickly supplanted by the reality of the profession.

My cap was the first casualty.


Fast forward to 2000.

I was working night shift in an emergency department when my colleagues and I decided to celebrate National Nurses’ Day by wearing classic white uniforms with our caps!

Yeah, baby!

Now, the last time I had actually seen my cap had been in 1979, carefully preserved in a halo of dust under the front seat of an old green Volkswagon bug I no longer owned.

Where on earth would I find another one – specifically one that looked like my nursing school cap. I mean, you can’t just wear any cap, you have to wear your school cap!

I was determined to find it.


I found it.

At a uniform shop located in a tiny trailer in a small parking lot in the next town sat an exact replica of my cap.

I carefully glued the forest green and gold grograin ribbons to the top, pinned the cap to my head and posed in front of the bathroom mirror. Only this time I didn’t wear a towel for a cape; it was the 21st century, after all, and I was more like a middle-aged Mrs. America.

The old thrill was still there.

The next night we faced the patients in traditional white uniforms with caps carefully anchored.


One younger doctor commented that I looked like his mother did when she was a nurse (uh….thanks?) and another revealed that he always had a fetish for women in white (o……kay).

The older docs loved it. The PM shift made fun of us (Nancy Nurse? Excuse me, my name is Ames…..Cherry Ames…..).

But, the patients! The patients respected us!

Their behavior was astounding. They spoke to us in lower tones. They spoke to us respectfully. They addressed us as “Nurse” and not “hey you” or “uh…where’s the doc?”

The age of the patient didn’t matter, even teenagers who probably never even knew that RNs wore caps mentioned them. The change in demeanor was so dramatic from our normal experience that I thought perhaps the nursing staff was acting differently while wearing the caps.

I decided to try an experiment and perhaps write a column on our experiences.


While my colleagues went back to their normal scrub uniforms, I worked in white, with my cap for a week.

We noticed that I was the go-to person if the patients had a question because I was easily identifiable as a nurse. The deferential attitude of the patients persisted.

I then went back to wearing whatever color scrubs I wanted, but always with the cap. In fact, I got so used to having it on that I would forget I was wearing it, so there was no impact on my behavior by this time.

The patient behavior did not change! I was treated differently when I wore the cap; the patients respected what the cap stood for.

I was floored.


Patients are bombarded with so many different personnel when they are in the ER, it’s often hard to keep track of who is a nurse vs. a lab tech vs. a housekeeper vs. the doctor.

Wearing a nursing cap gave my patients an anchor, a visual reminder of who I was and what my responsibilities were. However increasing number of male nurses entering the profession render nursing caps inappropriate. They say caps were a magnet for infection. They would get pulled off in the ICU. Caps weren’t practical.

Of course, all that is true.

But I sure loved wearing it.

(Addendum: I continued to wear the cap until I changed jobs soon after the experiment. The cap again found its way under the front seat, this time of my Saturn. And the column I never wrote? It turned into a blog!)

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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