November, 2005 Archive

November 20, 2005, 10:33 pm

Medicinal Compassion

So this is what Stefanie Powers did before she became “The Girl From U.N.C.L.E”! (A TV show from the ’60s, you young whippersnappers…). The intern with the cigarette breath and the full pack in his breast pocket is actor James MacArthur. God, I love trivia.

Smoking didn’t used to make one a social pariah. I didn’t smoke but my nursing colleagues in CCU did. They would all puff away while we would get report, sitting in the room in the middle of the unit! The odd thing was, it never bothered me. It never occurred to me that I should be bothered. Between my routine Hershey bar, coffee and their nicotine I was a very hyper, happy camper. If that happened today, I’d be choking and my eyes would burn. Somehow I developed politically correct physiological responses. The human body never ceases to amaze.

********************

It was a dark, stormy, late winter night. For weeks the Bay Area had been the recipient of a torrential deluge; a hard-driving, chill-to-the-bone downpour. I was working night shift in a quiet, “stand-by” emergency department.

We had cleared out patients left from the PM shift and finished our routine duties. About 0100 we were settling in for our usual night of nothing when a middle-aged man walked in and asked to see a doctor. He was a mess, his skin, hair and clothing thoroughly soaked. Water trickled to the floor as he sloshed to the triage chair.

He said he had chest pain. I started to run through the usual triage questions and assessments but soon realized something wasn’t right. His speech was clear, his answers vague. A vague smell of alcohol and stale urine permeated the area. He wouldn’t look me when he answered. I put my pen down. I had to know.

“Are you really having chest pain, or do you just need a place to sleep?”, I asked. For the first time, he looked me in eye and said, quietly, “I need a place to sleep.” He told me his story. He was homeless and an alcoholic. He had tried to take shelter under a bush in a park a few blocks away from the ER and intoxicated, had passed out. He estimated that he had been there in the rain for about four hours. His last drink had been just prior to walking to the park. He denied having any chest pain as he sat shivering in triage.

I put the patient in a room and gave him a gown and some pants along with a cocoon of warm blankets. I told the patient’s story to the doctor on duty. There was no eye rolling, no sighing, no anger, no sarcasm, no disgust. He asked me to see if there was any food in the back for the patient, said there was no way he was sending anyone back out into the storm and then went in to perform his examination.

We hydrated the patient. We gave him medication for tremors. We fed him (I found some soup and crackers) and gave him a safe place to sleep (which he did, soundly). It took a few phone calls during the middle of the night, but we were able to find a shelter he could go to in the morning.

I’ll never know what happened to the patient after that night, but I can tell you that I will never forget that doctor. Before laying eyes on the patient, he wanted to make sure a meal was available and decided the patient had a bed out of the storm. This doctor was a seasoned veteran of the ER with decades of experience behind him, yet he wasn’t cynical or hardened. He couldn’t cure alcoholism but he could treat this patient with dignity for the time he was under his care. He was no angel; he could be a bugger to the nurses when he was in a mood, let me tell you. For almost ten years I saw the respectful care he gave the less fortunate.

Compassionate medicine. He wrote the book on it.

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November 17, 2005, 1:35 am

Roses are Red, California is Blue

Well, I don’t know if I’d want to use this all in my own home! Actually, it is referring to an antiseptic solution. But what an odd photo…

First of all, it isn’t an operating room, no one is scrubbed.

Apparently the doctor requires three registered nurses to get the job done (no comment….).

No one is wearing gloves.

The patient doesn’t appear to need sedation, but is unable to bend her arm at the elbow to facilitate bandaging. Notice that the nurse is holding both the elbow and the wrist, but the doctor seems to have tucked the patient’s hand against his ribs. Must be one hell of a heavy arm!

A sterile field is set up along side the bed, but Nurse-on- the -left is holding the instrument in her fingers.

I have no clue what Nurse #3 is trying to get out of that cupboard, but it is awfully high. OSHA would have a fit!

Is that male head above the nurse on the right, the reflection of the photographer in a mirror?

We won’t mention the light directly on the patient’s face.

Thank goodness I don’t get worked up about this stuff!

hhhhhhhhhhhhhhhhhh

I live in the great state of California, in the totally crazy San Francisco Bay Area. Been here all my life. I’m a red-state soul awash in a sea of blue-state liberalism. Everyone feeds on their hatred of “Ahnold”. People actually believe Karl Rove tells President Bush to cause hurricanes- on purpose! We re-elect representatives and senators that have contests over who can sound the most idiotic. We’ll take the protection of the Armed Services but you had better not try to recruit in the City. Peace and Love, dude! We can’t give your daughter a Tylenol without your permission, but we can give her an abortion without you knowing. Our borders are so porous anyone and everyone can come on down illegally. Ooops, my bad…..I believe when you come into this country against the law you are now called an “undocumented worker”. But hey, no worries, you don’t have to be “documented” to get food stamps, health care, schooling, maybe a driver’s license and they are talking about free college educations! Best of all you don’t have to learn English! There are neighborhoods where you can’t find a single billboard in English! Even the Kellogg’s cereal boxes in my local Safeway are bilingual. The San Francisco Bay Area isn’t a melting pot, it’s a box of See’s Candy, all nougats and nuts….

But when I walk through the door of my emergency department, none of the above matters.

I leave my politics at home.

I couldn’t care less tell if a person is legal, illegal, documented, undocumented, insured, or uninsured. If you are sick you can walk into any ER in this country and obtain care. If you can’t speak English, we’ll find a translator to help you communicate. We’ll do our best to refer you to a physician fluent in your language. If you can’t pay we will give you a referral to our financial counselor for help in payment arrangements and give you referrals to low cost clinics for your follow up. If possible, we will give you discharge instructions in your native language.

Nursing is blind to ethnic, political or economic considerations. We deliver nursing care centered on our patient, respectful of their culture and with respect given to them as a human being. Every patient.

Oh, and that box of See’s Candy? I’m the section with the four, thin crunchy strips that are usually in the upper left hand side. Yes….it’s true….I’m a nougat.

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November 16, 2005, 12:11 am

Triage Tirades

I’m always happy to give advice on “heat- energy units”! Especially when I am standing in what appears to be a restaurant. In full uniform. Including cap and cape.

Aren’t “heat-energy units” now called “calories”?
So, according to Cherry Ames, Restaurant Advice Nurse, the more you feed your kid in the winter the warmer he stays. If that were true for adults I could run around in a thong in a snow drift….

Oh, but look! This Wheaties breakfast is sponsored by none other than Beulah France, RN! Of New York! You remember her! She went from inspecting toilet paper to sponsoring breakfast cereal! I hope she washed her hands…

Since when did nurses get endorsement deals?

Unfortunately I don’t think this is the last we will see of Nurse Beulah.

hhhhhhhhhhhhhhhhhh

A few years ago, it became a JACHO requirement to document how ERs were addressing cultural diversity. In the ER I was working at the time, the question, asked during triage, went something like this: Are there any cultural or religious beliefs that would affect your care today?

The usual response: a blank stare. Followed by, “What?” or “Huh?” or “I… don’t… think… so”. Apparently the general public did not find the concept of cultural diversity in health care as important as JACHO did. I’ve been asking that question for about three years now and in all that time I’ve had only three requests:

  1. A Jehovah’s Witness (no blood products)
  2. A Muslim (who was observing Ramadan and while able to take medications if needed, would prefer a medicine that could be taken once a day)
  3. A woman from Iran who would prefer a female doctor if possible.

Three positives out of literally thousands of triages, all of which would have been addressed during the course of the visit. No, instead we add it to the increasing number of questions/assessments required at triage. Oh, and don’t forget to chart “negative” on this one. If you leave the section blank, they think you have not addressed it.

Oh, and don’t even get me started: the gospel according to JACHO says that we have to measure the circumference of the head of anyone under the age of one. And then chart whether it is normal or not. What are we going to do about it in the ER? Acute head expansion in Bed 8A? Never mind that pediatric triages take forever! Oh, just work it into the triage, they say. Uh….. after we’ve worked to develop a rapport with the child, the trust of the parents, a full set of vitals including rectal temp done while listening to screaming that makes Dolby Surround Sound seem like an old RCA grammaphone, and obtain an entire medical and immunization history while the patient proves that a pissed-off infant has the vocal strength of thousands. Now we’re going to wield the tape measure. I worked in an ER where this was an actually watched in Quality Assurance. You could write up a triage worthy of Kipling himself and they would still find that damn little empty box-with-no-number. The hospital I work in now got around it in a rather interesting fashion. The nurses refused to do it! And somehow we still passed JACHO. Amazing.

Then there was the ER that required, for any patient coming in with a complaint of shortness of breath or cough for any reason, including infants, a ten-item questionaire to test for TB. Questions like:

  1. Have you had a fever in the last 48 hours?
  2. Were you born in this country?
  3. Have you been in a homeless, in a shelter or incarcerated in the past year?
  4. Have you had a cough?
  5. Have you had night sweats?
  6. Is your cough productive?
  7. Do you smoke?

You get the picture. Imagine having to ask these of a two-week-old. Obvious MI? If the words “short-of-breath” came out of the patient’s mouth, you had to do the screen. Croup so loud you could hear it three floors up? You had to do the screen. Status asthmaticus? Yep, the screen. Six week old with RSV? Screen ’em. Now there was nothing wrong with the screen itself except that it was a pain in the derriere when added to the triage. Most of the time, a waste of time.

And the icing on the cake? There was a separate sheet with SARS questions on it.

I bet Beulah France, RN from New York had something to do with it.

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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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