January, 2006 Archive

January 22, 2006, 2:34 am

Life Begins At 90!

I found this little nurse doll online and fell in love with her, although her cap is sort of out of proportion…

Boy, that last post on migraines sure inspired a lot of comments. It also introduced me to some excellent discussion boards and weblogs – I’ve now added a “Patients of the Blogosphere” link to the sidebar. Check them out for a look at us from the perspective of a patient. I’ll add more as I come across them. I’ll also be adding more in the paramedic section, too.

Usually I have a ton of time to blog, but no ideas. Now I have little time to blog and a TON of ideas! So tomorrow, it’s just me and my blog…..

After I attend my grandfather’s 90th birthday party tomorrow!

One day I’ll tell the story of how he set off the LifeAlert system while climbing onto his roof to fix a tile. In his eighties. Couldn’t figure out why all those sirens were coming closer and closer until they stopped in front of his house. Caught red-handed, he was!

He stopped a 4-pack-a-day cigarette habit cold turkey in 1963. I asked him if he still wanted a cigarette. He said sure, but wantin’ didn’t mean he had to have it. They just don’t make ’em like that anymore…

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January 19, 2006, 12:23 am

Ambivalent Compassion – The Migraine Sufferer

I wish the dialogue was visible on this ad for Colgate toothpaste.

Wifey in gorgeous robe is upset because her husband pays no attention to her and not even her “illness” has changed his attitude.

Nurse Subtle informs Wifey that she has seen “bad breath” break up so many marriages.

Apparently Wifey’s breath makes a cat-box smell like springtime in Paris.

Why, let’s get a dental consult. Right here in the hospital.

Dr. Dental tells Wifey that her bad breath is caused by putrid, decaying animal flesh stuck between her teeth and saliva that’s a-liva with bacteria. He prescribes Colgate.

Wife is shocked that she, of all people, should have to brush her teeth.

She tries the Colgate “dental cream”. “Illness” cured.

And her marriage to her shallow, non-communicative husband who didn’t have the cohones to mention her breath issue and won’t even visit her when she is sick in the hospital is saved.

Much of the above dialogue was paraphrased by yours truly. But you get the idea.

Today’s ads are Pulitzer-prize material compared to this stuff…..

hhhhhhhhhhhhh

Having been a nurse for as long as I have, I am definitely not naive. I don’t consider myself cynical, either. I like to think I have reached a fine balance between the two that allows me to treat my patients with compassion and detect (and deflect) the bull that some patients will occasionally throw my way.

Nowhere is this balance of compassion and cynicism more obvious than with caring for patients with chronic pain issues. For this post I will focus on the migraine patient.

I’m no stranger to headaches. Twice in my life I have known what it is like to feel like your head is going to explode. So, the first thing I do after assessing my migraine patient’s color in the triage room is I turn out the light before I get the history, as most of the patients will suffer from photophobia.

I make sure they have a private room with the lights out whenever possible. Sometimes they have to wait a bit longer for the advantage, but I let them know why they are waiting.

For new patients I ask them what has worked in the past. Some don’t know, others can recite specific dosages. I ask because if they know, it saves a lot of time and the need for re-dosing. If a patient states that it usually takes 100mg of Demerol, IM, to take the pain to a tolerable level it seems silly to give it in 25 mg increments. Oh, the doctors can order it that way, but (1) trust me, it will NOT work until the usual dose is reached and (2) the patient stays longer in the ER because of the need to re-evaluated after every administration of the med.

Hopefully the doctor has given them prescriptions for pain at home. I make sure the patient has a ride home. I have bad feelings about putting a female patient under the influence of a narcotic into a taxi, although they will often insist it is their only way home.

And this brings me to the cynical side of my migraine ambivalence.

I’ve been burned.

  • I had a patient appearing very ill (headache, vomiting, photophobia) and placed directly into a room. It was discovered that just an hour before, said patient was at our “sister” ER and both departments worked off the same computer system. All it took was one phone call to ascertain that the patient had received enough narcotics to allow him to have floated to our facility. Well, he just floated back home without anything from us!
  • Sometimes a nurse will work in more than one facility. One of my patients was identified as having been at another facility already twice that week for the same complaint: migraine. I believe I already told the story in another post that related a nurse traveler who recognized a drug seeker from the east coast while working here in CA.
  • There are the patients who take the taxi, drive around the block and then get in their car and drive off. I know this happens because the taxi drivers come back and tell us the patient only went to the corner and then got out of the taxi and walked back up to the parking lot.
  • If “New Miracle Drug” comes out on Wednesday and the patient states he is “allergic” to it on Friday, it usually means that somewhere, somehow the patient received the medication and it didn’t work. Saying there is an “allergy” to a medication is one way an illegitimate drug seeker will keep from getting that drug.

This is what ruins it for patients with legitimate pain issues that occasionally need to be addressed by the ER.

If you are a patient with a chronic/recurrent migraine issue:

  • Carry with you a letter from your neurologist outlining your treatment plan, discussing what to do in a case of breakthrough pain and gives medication/dosage recommendations. Make sure it is updated often, in other words, don’t bring a letter dated 2000.
  • Bring a list of your medications and allergies/reactions with you. The apex of a migraine is no time to be trying to think of your medications. Keep it in your purse/wallet.
  • Bring your ride home with you. Don’t take the chance you’ll be medicated and have no way to get home. Don’t drive yourself to the ER when you are in that much pain, it isn’t safe.
  • If you are certain that your pain is unmanageable at home with what you have available, it may be worth placing a call to your doctor. Often, they will call ahead to the ER so that we are expecting you. They may even talk with the ER doctor to discuss your case and treatment options.

So you can see when you run into staff who seem suspicious or less than compassion filled, maybe you now have some insight as to why some ER staff tends to be on the “cynical” side when it comes to pain issues.

There is a line in the movie “Ghostbusters” that shows the guys in a TV commercial saying, “We are ready to believe you!”

We are ready to believe you here in the ER, too.

But trust me, we can spot a phony a mile away.

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January 17, 2006, 1:50 am

Don’t Just Stand Around! It’s Grand Rounds And Time For The 2005 Medblog Awards!

Who says there’s a nursing shortage? Why I found these with no trouble at all!

Looks like they are standing around for Grand Rounds hosted this week by Allen over at Grunt Doc.

Tuesdays in this house are beginning to be known as “Dusty Days” because nothing gets done around here as I’m too busy reading Grand Rounds!

It’s not like I ignore my familial responsibilities.

Really, I don’t…..

Hey, how come there are only two brunettes in this entire batch of nursing dolls?

Of course, in reality, with the aging of the nursing force, half of them would have to have grey hair and the other half grey roots!

hhhhhhhhhhhhh

Well look at this! Seems Miss Cherry Ames, RN had an endorsement deal with Coke!

Well I think we should join her in a well deserved toast to the winners of the 2005 Medical Weblog Awards that will be announced today over at Medgadget .

You know how they say after the Academy Awards that just to be nominated was an honor?

It really is!

Thanks to all who gave Emergiblog their vote.

Have a Coke in honor of the winners!

As for me, I’ll go open the champagne the ER doctors gave the nurses as a Christmas gift this year!

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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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