March, 2006 Archive

March 6, 2006, 9:43 pm

Welcome To Grand Rounds (Redux)

Welcome to the Emergiblog edition of that wonderful weekly compilation of everything that is great about the medical blogosphere!

Yep, it’s Grand Rounds!

Right on my own blog!

Excuse me for a moment whilst I don my professional demeanor. (I’ve been running around the room yelling “YES!” and pumping my fists in the air ever since Nick told me this was my week!
Until I posted the Rounds on Monday night, went to fix a few links and found that my html had become unrecognizable. Was it me or Blogger? I have no idea. What you will be reading and seeing is a resconstruction of one week of work in less than one night. Do I have your sympathy? Excellent! Now let’s get to business!)

(Takes a breath)

There, that’s better.

I’ve chosen our Dixie Cup nurse as the Grand Rounds mascot this week because this is exactly how I read Grand Rounds every Tuesday. With a cup of coffee (or three!) in my hand.

I do not, however, drink from a dixie cup.


Our theme this week is “Grand Rounds in the Emergency Department”! And since no one is ever turned away from an ER, all submissions will be seen, but not necessarily in the order that they arrive! They must first be “triaged”.

So please, have a seat in the triage room, your nurse will be with you in a moment.

TRIAGE!
Because we do what we do for the patients, I decided to put our patient bloggers here in the “Triage” section, right up front.

Amy at Diabetes Mine gives some straight talk on the “herbal remedies” and dietary supplements that supposedly “cure” diabetes. Check it out at Herbal Remedies If I was ever diagnosed as a diabetic, Amy’s site would be the first place I’d go after seeing my doctor.

Jenni is the “editrix” of Chronicbabe and she submits a post written by Laurie Edwards entitled In the World of Doctors, First Dates Matter. Great, upbeat site for patients with all types of chronic illnesses. Laurie notes how her husband and the doctor who she works the best with share the same qualities. Interesting perspective.

Our friend, Nurse Practitioners Save Lives looks at her experience on the other side of the siderail over at The Nurse Practitioner’s Place in the post NPs Save Lives Goes Under the Knife. When you are done reading the submitted post, go to the main website and read the post previous to this. A very powerful look at what our patients (and we) think pre-op. I believe the phrase “kiss my missing meniscus” shall be my professional motto.

My favorite Difficult Patient recounts a horrendous experience in The Emergency Department: ARMY Style. One can only hope that there have been improvements in the last twelve years. If you know a military family, let them know you are available for help if they need it.

At HealthyConcerns.com , Elisa says “People blog a lot about health care gone wrong, but my first experience with non-routine care at Kaiser went smoothly, and I figured it’s only fair to share the good patient experience too!” Read about her experience at Healthy Story: You Know I Give Props When They Are Due

EMERGENT!
In the emergent category we find the “Top Ten” posts of the week as judged by, well, me, the woman who was made “more than romance”.

#1 – First place in my “Top Ten” this week goes to Rita’s submission from MSSP Nexus Blog and her post on patient safety: Triumph Built on Tragedy. She includes a link that I feel is important enough to include here: Josie King Foundation.

#2 – What do you do when your patient has run out of options? Keith over at Digital Doorway took my breath away with his post entitled How Do We Move On From Here?

#3 – TC at Donorcycle sees life through the eyes of a transplant coordinator. How do you approach a family and when? Check out There’s No Good Time

#4- I didn’t know whether to laugh or cry, either, so I did both. TSCD at Sunlight Follows Me tells of a “lost” patient at Lost and Found .

#5 – Mary at The Mote in the Light hits home with a post about children with multiple disabilities in the ER. It’s called Anybody Know Anything About This Kid? There are some good links within the post. Check it out.

#6 – I’m a sucker for an English accent, even on the internet. Dr. Crippen, our well known colleague at NHS Blog Doctor initiates a discussion on What Do You Call the Patient?

#7 – Miracle Workers? Not Doctors. was submitted by Graham over at Over My Med Body I would like to make copies of this and hand it to every single patient who walks through the ED door.

#8 – Interested in the state of the nursing profession in the United States? I’ve never heard it said better than over at The Blog That Ate Manhattan. The post is entitled: Bi-Continental Bitching, but there is no bitching. Just an insightful, consise look at the nursing profession from a physician with a patient’s viewpoint. I wish I had written it.

#9 – Keagirl at UroStream offers some good reasons to assess your undergarments at Clean(ish) Underwear Wanted. Newly minted MDs beware, after this you may want to pass on that urology residency!

#10 – Occasionally things in the ED get hot and heavy. Our pediatric colleage, Flea gives us our Grand Rounds “Code Three” of the week at When Kids Leave Home and the Dog Dies Don’t let the title fool you and don’t read it without checking out the comments section!

#11 – Being the closeted rock groupie that I am, what’s a Grand Rounds without a Spinal Tap moment? So I’m emulating Sir Nigel Tufnel and taking it to “eleven” with a post of my own entitled They Called Him “Mac”.

URGENT!
Here in the urgent category we have submissions pertaining to patient care.

Whoa! Dr. Kevin at Kevin,MD gets a fiesty comments section going when he posts a blurb on Why This Mother Dumped Her Pediatrician ! Watch out for flying scalpels! And pacifiers!

I thought I had a warped sense of humor. Well Dr. Michael C. Hebert at the (appropriately) named Michael C. Hebert, MD – Journal has a post that will make you laugh. The Kool 100 . I can’t even give a synopsis and do it justice. You’ll have to read it!

I am personally familiar with incapacitating nursing burnout. Our Cheerful Oncologist takes a look at doctor burnout in The Hidden Lives Of Doctors, Part IV . The post is great, but as usual, there are wonderful comments attached.

Helen is a reader of the Nee Naw blog, run by London ambulance dispatcher Mark Myers. She could not believe this horrific story and neither can I. Check out Caring Goes Out the Window . And then pick your jaw up off the floor.

Our Wandering Visitor discusses informing patients of exactly what a “code” entails in the appropriately named post, Codes.

Shadowfax at Movin’ Meat weighs in this week with Well That’s Just Not Fair . I used to joke that if I could tell your scan was bad, you were in trouble because I’m not radiologically literate. That’s not funny anymore.

Dr. iBear at Doc Around the Clock tells a humorous and poignant story of a patient almost cured in The Hunchback of Notre Dame.

Dr. Emer at Parallel Universes gives us three of his most memorable ED shifts at Notable ER Stories

It’s our early successes that build the most confidence and paramedic student PDX EMT at Drug Induced Hallucinations describes one of his success stories at Tales From the ED (1).

The ED doesn’t often get of view of what it’s like “upstairs” when we send a patient, but this week GeekNurse gives us a peek into a PICU admit in Incoming! God forbid you should ever need a PICU, but if you did, you’d want this nurse at the bedside.

This post from Jodi, in her last months as a student nurse, at Coffee and Conversation In A Smoky Room had steam coming out of my ears. It’s called Scut and it’s about her ER experience. Why do nurses treat future colleagues like they have the plague?

It just wouldn’t be Grand Rounds without a visit from Doc Shazam at Mr. Hassle’s Long Underpants and a very poignant story about The Blind Man and the Butterfly

Dr. Aidan at The Examining Room of Dr. Charles takes a lighthearted look at Medicare Part D (is that an oxymoron?) in Bridging the Gap – One Doctor’s Approach To Explaining Medicare. Wish him a quick recovery, won’t you?

Whether you are a fan of Johnny Cash or not, you must check out this post submitted at
Clinical Cases and Images – Blog. A very unique post for Grand Rounds, it includes a video of Johnny’s rendition of “Hurt”. Powerful.

New to Grand Rounds, Barely, MD discusses the Avian Flu (H5N1) and Why We Care. and the relationship between research and journalism at Premature Birth and Journalism. Hits a double on his first “at bat”!

Welcome.Big Mama Doc looks at Formalities on this side of the Atlantic at Fat Doctor . What ever happened to respect?

Our favorite Internal Medicine Doctor reads between the lines in a medical/sports post at Doctor as he points out some informational discrepancies in Does Ian Thorpe Have HIV? Let’s hope this world-class athlete can shake whatever it is that is plaging him.

He’s new to Grand Rounds, he teaches anatomy and he’s starting medical school in September! Let’s all give a Grand Rounds welcome to Brad Wright at Anatomy Notes who describes for us his experiences with Nasal Irrigation (his own). He uses only the finest ingredients, not the least of which is humor.

NON-URGENT!
Here in the non-urgent, but no less important, category are submissions that look at hospital life and patient care “behind the scenes” through an administrative capacity, or posts that delve into research and its applications.

Bob from the Health Care Law Blog reports on a new forum for health policy blogs. Get the details at New Carnival: Health Wonk Review

Grrlscientist from Living the Scientific Life (Scientist, Interrupted) submits a fascinating post on the Avian flu. In her words: “A new report (linked) shows that industrial poultry farming is smack-dab in the middle of this avian influenza crisis, NOT WILD BIRDS, as is so widely reported. So what shall we do about this?” See Avian Influenza: A Story About Industrial Fowl Play?

Eat dirt! No, that’s not the latest put down, but the subject of Dr. Andy ‘s Grand Rounds submission this week: Eat Dirt, Prevent Asthma! Hmm….I’d love to see the dosage on that!

Kate at Healthy Policy looks at the pros and cons of employer-based healthcare in Do We Want to Keep it With Employers? Is it a system we keep, or should we forego it altogether?

Truma teams are amazing. I’m lucky enough to live in an area with many Level I facilities. Dr. Bard Parker at A Chance to Cut is a Chance to Cure tells us why in his submission entitled Practice Makes Perfect V. He explains the difference between designation and verification in Trauma Center Confusion.

A second post at Clinical Cases and Images-Blog has to do with Residency Program Blogs These are blogs by residents for residents. Links to examples provided.

Tony at Hospital Impact submits a hilarious post by Nick Jacobs entitled Classic Email Thread At My Hospital. Sounds familiar, doesn’t it? And do not miss the link at the end re: the email between two attorneys.

Ruth over at The Biotech Weblog looks at Detecting Exposure to Bioterrorism Agents Using Genetic Blood Test. Cutting edge research, with potential applications for other diseases.

Coturnix over at Circadiana submits a post on the Diurnal Rhythm of Alcohol Metabolism. If you are running out of booze, better drink in the morning!

Chemist Gloria submits her post at Straight From The Doc discussing studies showing that Xenon Gas Prevents Postoperative Brain Damage in Bypass Patients

In keeping with the cerebral function theme, Sumer at Sumer’s Radiolgy Site references a study on Quantifying Stroke Related Brain Damage. Short. To the point. Impressive.

InsureBlog contributes with a post submitted by H.G. Stern with the great title of InsureBlog: Perry Mason vs. Dr. Kildare. Can medical malpractice reform actually lead to lower health insurance rates? Better service? Good links with additional information.

Tara at Aetiology gives her input on the “Superbug” Hit List Published by the Infectious Disease Society of America. Pardon me for a moment while I go wash my hands….

Adam Scavone submits an interesting post from The Agitator. Per Adam: “Radley Balko is following the appeal of Dr. Bernard Rottschaefer, who is being prosecuted by the D.E.A. in their war on pain doctors…They’re accusing Rottschaefer of not being able to correctly identify a patient who was lying to him… the prosecution of pain doctors for not being omniscient needs to be known. The post is at: Rottschaefer’s Appeal This Week: Comments.

Kumbaya? Dmitriy, the Publisher of The Medical Blog Network reports from the California Regional Health Information Organization, Summit III, making sense of how capable are RHIOs of truly serving the interests of consumers. What Is Rhetoric and What Is Reality? I’m hoping the ED linking is the “reality”!

David at Health Business Blog wonders Can Blogging Boost the Rate of Progress in Medicine? I’d love to find out the answer to his hypothetical research example! It would explain a lot!

Our friend over at Interested Participant jumps in with Macho Mammas Give Birth to Boys (!) and I think I’ll let him give the synopsis: “Scientists have established that eggs taken from female mammals have varying levels of testosterone and that those with the highest levels are more likely to develop into male embryos.” Intriguing findings, but all I can picture is women with beards!

(Epilogue: I’ve spent nine hours re-doing the work of an entire week. Twice. Blogger is bad and Firefox crashed. I apologize for how this is going to look online, but if I don’t post, I’ll lose it again. News in my next post. Next week’s host: GeekNurse . Don’t forget the Grand Rounds archive on Blogborygmi and Nick did a prerounds interview with me on Medscape – I’ll get that link tomorrow. When I stop seeing links before my eyes. For now it’s GOOD NIGHT NURSE!)

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March 5, 2006, 10:46 pm

They Called Him “Mac”

Today’s post is a long one, but it’s a story I have to tell.

My sense of humor is on the back burner this time, but not for long. You may even get an idea of where it comes from

I did want to include this photo of a fan that is actually an advertisement for Tums!

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

My blog-friend Kenju over at JustaskJudy has a huge collection of these and I knew she would appreciate seeing it here!

It was cold and overcast in Modesto that day that Mac presented through the ED doors via paramedic transport. February 20, 2000. He was a big man. Six feet tall and about two-hundred and forty pounds. Retired CHP lieutenant. Active in his local Masonic lodge. Married his high school sweetheart at 18. Had three grown kids and a slew of grandkids. Sixty-two years old. An artist. His name was Kendall Hall McAllister, but everyone who knew him called him Mac.

“WHO IS THIS?”, shouted some guy in scrubs. “WE WEREN’T EXPECTING ANYBODY! PUT HIM IN THE HALLWAY.

Mac’s wife thought they were putting him there to die.

ddd

Mac’s trip to the ED had actually begun the night before as he was working on his Windows desktop. It was his turn to edit the fraternal organization’s newsletter and it was nowhere on the computer. His wife said he became angry, almost to the point of being in a rage. Very odd behavior that did not stop.

Exasperated with this demonstration of frustration, she told him, “Mac, you have a stroke and I am shooting your computer!”

ddd

The next morning, Mac sat up and stretched, got out of bed, took about five steps to the bathroom and fell to the floor. He had no feeling or movement on his left side. None. As his wife ran to his side she heard one, muffled sentence:

“Don’t shoot the computer.”

ddd

Now Mac truly lived out in the “boonies”, about an hour out of Yosemite, so the closest facility to him was in Merced. The medics proceeded there “Code Three”. Most of Mac’s family lived within an hour’s drive and were at his beside when I came on the scene. All the hustle and bustle of lab work and CTs were done. I mean, what else are you going to do once a stroke has hit? Couldn’t even consider TPA because it was hemorrhagic.

I saw your typical stroke victim. For all intents and purposes, Mac’s left side was dead. Facial droop. No reflexes. Not one. Speech slurred because of the left sided facial paralysis but no expressive or receptive aphasia. And a surprisingly upbeat affect. When his wife said, quite seriously, “Mac, you’ve had a huge stroke and you can’t move half of your body. Aren’t you upset by that?” His answer: “Yeah, I didn’t get my coffee this morning!”

ddd

The closest facility that specialized in neurology was in Modesto, and that is where Mac was transferred. Where they tried to put him in the hallway.

But let me give you some background about Mac’s family. Three nurses: one trauma nurse, one ED nurse and one L&D nurse you would not want to meet in a dark hallway if things weren’t perfect. The kind of family member the nurses all hate. She spoke to the nurse manager.

Mac had a room within five minutes. A private room.

Oh, and did I mention that prior to transport Mac had regained the use of his left side? All of it. A slight weakness remaining. That was all.

Doctor’s Hospital in Modesto was such a bastion of neurological services that they had no beds on the neurology floor. So Mac was admitted to the oncology unit. A pretty, home-like unit where Mac developed severe headaches that were not medicated. And persistent vomiting. But he was alert and oriented. And not a neurologist in sight.

A neurologist had not even been consulted.

It seemed as if they were writing off this vibrant, active man.

This time it was the ED nurse family member who professionally, assertively and ever so extremely politely demanded a neurology consult. STAT.

A neurologist came, seemingly reluctantly, and examined Mac. He then looked at the CT of the head taken in Merced. His exact words were:

“If I had seen the x-ray before I had examined him I would have expected to see essentially a vegetable. The entire right side of his brain is essentially gone. The level of recovery I see is nothing short of a miracle.”

Miracle. Not a word I hear neurologists throw around very often.

The family did the usual grilling. Question after question. It was pretty obvious that Mac’s wife was not comprehending a single thing. Good thing the family was with her.

Especially when the “Social Worker” came up to her after Mac had been at the facility 48 hours and told her he was being transferred to a convalescent home. She lost it. Mac’s brother called the ED nurse family member and repeated what was said.

In the world of hospitals there are two phrases that will chill the soul of a hospital administrator. One is “Standard of Care” and the other is “you are dumping this patient”. The ED nurse ever so extremely politely advised the administrator of nurses that transfer to lesser care 48 hours after an acute brain infarct was not the standard of care in the state of California and that it appeared Mac was being dumped due to a lack of beds.

It seems that the “Social Worker” had spoken to the wrong family.

Oooops.

ddd

Mac did so well he was in rehab for only a week or so before going home. The first thing he did when he got home was find the newsletter on the computer that bedeviled him just a couple of weeks before! Then he wrote thank you letters to everyone who had sent cards and flowers. He drew some editorial cartoons and voted in a local election. He scooped cat litter and carried in wood. About the only thing the stroke left him with was a rather mellow affect and the need to talk. A lot. Especially on the phone to his kids. He had beaten the CVA.

ddd

On March 10, 2000, Mac’s wife found him writhing on the bed, clutching his chest and complaining of being unable to breathe. He was pale and diaphoretic.

The medics came. There was no way in hell the family was going to allow him to be taken to Modesto. They requested Fresno.

He told his wife “I love you” at the door.

The ambulance drove the half-mile to meet the LifeFlight craft that would take him to the largest hospital in Fresno. Mac was lifted into the craft as one of his son in laws watched. Mac then removed his oxygen mask, crossed his legs, put his hands behind his head …..

……and coded.

ddd

They were still pumping on his chest when the family members from Fresno saw him taken off the LifeFlight. They worked at that facility.

ddd

Kendall Hall McAllister died of a massive pulmonary embolism.

He lived from January 31, 1938 to March 10, 2000.

They called him “Mac”.

But I just called him “Dad”.

And there isn’t a day that goes by that I wouldn’t give my life to have him back.

I love you, Dad.

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March 3, 2006, 1:01 pm

She’s A Super Freak?

We have a new role-model here at Emergiblog today. Her name is Nurse Margaret Kissack and she would like to have a word with you ladies.

It looks like she is using her nursing pin as a top button because she doesn’t want to show cleavage.

And I don’t know what is coming out of that bag but it sure doesn’t look like a syringe to me, feminine or otherwise.

Emergiblog is rated “PG-13” so I won’t say what I really think it is.

Don’t let that stern demeanor fool you for one minute.

Who do you think was the inspiration behind the line “She’s a super freak, she’s super freakin’ yowwwww….”

I shall say no more.

Except to give my deepest apologies to Rick James, may he rest in peace.

hhhhhhhhhhhhhhhhhh

Well, I was going to regale you with the pathology reports on the dermoid “cysters”. Let’s put it this way, Barry the cyst could have applied to Harvard.

I have the only child on earth who clones herself.

Instead, let me ask a rhetorical question:

What do you do when a 10-inch, dark pink worm presents itself to the world through the mouth of a human being?

You name it “Freddie” and send it pathology.

That’s my rhetorical answer.

And how was your day?

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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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