February, 2006 Archive

February 7, 2006, 4:30 am

Operation Grand Rounds

That guy in the middle row. Third from the right. He looks thrilled. Probably wants to be a skin guy and could care less about a gall bladder.

The guy in the same row, second from the left is so daft that the guys on either side of him have to explain what is happening.

But that was then and this is now.

Now we have operation Grand Rounds this week over at Cotournix’s Science and Politics blog

But long before I knew him as “Cotournix”, I knew him as just “Bora” from the Circadiana blog.

He gave Emergiblog its very first link.

Always wanted to express my appreciation.

Thanks Bora!

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February 6, 2006, 2:40 am

Dorothy Hamill and Andy Gibb = One Theraputic Relationship

Looks pretty reasonable to me.

Sit on your butt. Read a book with Lassie at your side, your feet on an ottoman and your wife cooking a big juicy porterhouse steak for dinner (hey, this was from the ’50s, okay)

The text of this ad says that “physical activity is generally curtailed and overwork is avoided”.

For some reason that is not the advice my doctor gave me for hypertension.

“….and the use of stimulants is restricted.”

Okay, that makes sense…

Except that when I exhausted every means of research (my famous “I feel lucky” Google click), this medication is a vasodilator and a myocardial stimulant that lasts longer than caffeine.


Oh, silly me….it also has phenobarbitol in it! I guess back then you could sedate your way to normotension.

I saw my doctor and all I got was a stupid diuretic and the advice to move more. And it works!

Without sedation.


In my search for nursing/medical ephemera for the blog, I’m usually laughing my head off and mentally writing the story to go with it.

This one did not make me laugh.

I don’t find much to laugh about where mental illness is concerned.

This medication is supposed to take someone on the edge of what I assume to be (schizophrenic?) psychosis and turn them into an attractive college co-ed.

Click on the image and try to read the print, it’s small but you can make it out.

I worked for 2.5 years in a psychiatric unit and never saw anything like this ad portrays.

But it did bring back the memory of my psychiatric rotation in nursing school.

And a patient I will never forget.

We were both eighteen.

I was a first-year nursing student on my first day of psychiatric clinical. Melissa sat rocking in the corner in a chair in a psychiatric facility. I was supposed to pick a patient to be my “case” during the rotation.

“Why are you rocking?” I innocently inquired. Queen of theraputic interaction, that was me.

“It makes me feel better. You look like Dorothy Hamill.”

In case you are wondering, I had been told that before. She was not hallucinating.

“Gee, thanks!” I replied.


“Do you like music?” I asked. I had no clue what I was doing. We were the same age and I was so into music that my second choice for an occupation could easily have been “rock groupie”.

“Yeah. I like Andy Gibb.”

Oh….my…..god……that sealed the deal. This was my patient.

I was in love with Andy Gibb. So let’s put it all together: same age, she thinks I look like someone I’d been trying to look like for a year, and she had the same taste in music.

I knew I would be comfortable with her as my patient. In retrospect, whose needs were being met here?

I asked her if she would allow me to be her “nurse” for the next six weeks and she agreed.

During that time we walked and talked. We worked on hairstyles and personal grooming. As we sat on the grass outside, she told me about her family and voices that came from nowhere. No, they never told her to hurt herself. They just told her that she wasn’t very good. Or pretty. Just worthless.

“Why,” I wondered aloud, “don’t voices ever tell people that they are beautiful, smarter than the whole world and have the greatest hair on earth?”

We nearly split a gut laughing at that. I’m sure it wasn’t the “theraputic” way of dealing with auditory hallucinations, but it really was funny. At the time.

She was very sick. Her diagnosis was “acute schizophrenia”. I thought that because it was “acute” that it was curable. I had so much to learn.

The plan was for Melissa to go to a half-way house and she was going to be able to tour a few so we began making a list of what she would like in her new “home”, what she would be looking for as she toured the various facilities.

The end of my six-week rotation was nearing and I had to prepare Melissa and myself for the fact that our relationship would be ending. I’m not sure who it was harder for, Melissa or me.

She cried. I managed to keep a professional facade and explain that while I was also unhappy, it was how things needed to be.

Melissa spent one more of our “rotations” at the psych facility, during which another student in my class took her case. Melissa asked about me every clinical day, but it was not appropriate for me to send any messages or to interfere with my student colleague’s relationship with her client.

On the last day of our clinical, Melissa handed me a piece of paper. I was just walking out the door and I told her I would read it when I got home. She seemed happy with that and I left the facility for the last time.

It was a note thanking me for being her “nurse” and a request that I always remember her.

That’s when I cried.

I have thought about Melissa often over the years. Where she is. How she is doing. Was she sad when Andy Gibb died? It is because of Melissa that I have always viewed psych patients as people who have a diagnosis, but are not a diagnosis. It is because of Melissa that I had over two wonderful years working with psych patients. It is because of Melissa that I realized psych nursing is the one place where just being yourself can be theraputic.

Melissa, wherever you are, I have always and will always remember you.

Addendum: For those of you who are watching “Skating With the Stars” and see Dorothy Hamill every week, let me assure you that I am now the equivalent of 3 or 4 Dorothys and about the only thing we have in common is that she skated in the Olympics and I watched the Olympics….but I am dying to get that new haircut she has!

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February 5, 2006, 12:11 am

You’re In the Pepsi Generation!

I knew it.

Nectar of the gods.

They used it to “force” fluids!

It was good for you.

JAMA said so in 1956!

Did they not know that it was full of caffeine and would cause a mild diuresis, precipitating a loss of fluid?

So freakin’ what!

(I love this stuff. I live on the diet version. The folks at the local KFC and Taco Bell know me by name.)

I remember the days of the “force fluid” orders.

How on earth are you supposed to “force fluids”?

You can facilitate, encourage, offer, nag, hassle, guilt trip and threaten a giant intravenous line.

But you can’t “force” fluids . Unless it’s diet Pepsi. And the patient is me.

Here is a personal story about the wonderful concoction known as diet Pepsi.

Which, if I don’t have it, qualifies as an emergency, hence the relevancy to Emergiblog.

I once paid a visit to my doctor for a mild headache that had lasted four days.

Nothing would take it away. Not Tylenol. Not ibuprofen. I’d wake up with it. I’d go to bed with it. Four days was long enough. I made an appointment.

So I give, precisely and in detail the “history of present illness” to the physician’s assistant.

I emphasize that it has nothing to do with caffeine withdrawl. I have a constant caffeine level.

“Really?”, she replied. “What is it you drink?”

“Oh lordy!”, I said. I have at 44 ounce diet Pepsi in my hands at all times and I drink at least 2-3 cups of coffee a day. I usually pour 5-6 cups, but work gets busy and I don’t have time to drink it.”

“Do you drink any water?”, she inquired.

I thought long and hard about this obviously complicated question before answering.


Turns out that my headache was due to dehydration secondary to drinking nothing but caffeineated beverages.

Oh geeze.

Now I am an all-or-nothing type gal, so I decided to test this hypothesis by cutting diet Pepsi cold turkey. None. Nada. (I knew I had to keep the coffee or I would have caffeine withdrawl.)

I began drinking water.

Lots of water.

Bottles and bottles of water.

I drank so much water that I was personally responsible for the San Francisco Bay dropping two inches. Ships had to re-route so they wouldn’t get stuck in the Golden Gate.

The headaches stopped.

For six weeks I denied myself the caramel-colored-aspartame-loaded liquid gold with the beautiful sound of tiny carbonated bubbles bursting in their carbonated way.

I re-introduced the diet Pepsi slowly.

I now allow myself one large fountain diet Pepsi per day or one 20 oz bottle if I am at home.

I still drink water, but the shipping forcast for the Pacific region has returned to normal.

But, you ask, why not diet-caffeine-free Pepsi?

It tastes like Robitussin.

Disclaimer: I am in no way employed by or compensated by Pepsi Co. or any of its affiliates. I am, however, open to offers.

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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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