August, 2006 Archive

August 17, 2006, 9:58 pm

Notes From a Rockin’ Couch Potato

babyrockDid hell freeze over?

I, the Queen-of-Rock-and-Roll’s third cousin twice removed is sitting home while less than 25 miles away, REO Speedwagon is on stage.

And here I sit, blogging.

I’m not sure if it’s dedication, perserverance, a love of the written word, an addiction or…

Laziness.

I just couldn’t get up and get myself to the venue.

Nevermind that I have loved REO Speedwagon for nineteen years.

Nevermind that I have only seen them once in concert, and that was because they were touring with Journey.

Nevermind that I could have had seats right up front, or thereabouts.

I didn’t go.

The only other concert I’ve missed was Rob Thomas and that’s only because I had vertigo!

So I’m sitting here feeling sorry for myself, but quite comfortable on the couch.

I’m gonna regret this tomorrow……

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Rumor has it that “The Answer Nurse” will be touring, once again to be interviewed here at Emergiblog!

So think of all the questions you always wanted to ask a nurse but were afraid to know. The Answer Nurse requests that only questions denoting a proper social demeanor be posed, as anything of an inappropriate nature disrupts her delicate constitution.

Simply pose your question in the comments section and Emergiblog will forward them to The Answer Nurse.

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Get your “ticket” to the best (and probably only) nursing blog carnival around! That’s right, Change of Shift returns to the Emergiblog Arena on August 24th!

The cost of the “ticket” is one submission from your blog of a post related in some way to nursing (the profession, not the feeding technique). You can also send in a post from another blog on the same theme, but make sure you get the blog owner’s permission!

The best way is to use the Blog Carnival submission form on the sidebar of this blog. You can also send them to the Emergiblog “ticket office” via email.

But be sure to get your submission in by August 23rd!

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New post up over at Scared To Health……

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8:54 pm

Just the Facts, Ma’am: Talking to Doctors

pepsi

Awwwwww….

Look at those itty bitty wittle Pepsi cups!

No thanks!

Speaking as someone who thinks the arrival of the KFC Mega-Jug is on par with the discovery of penicillin, I hope they didn’t have to pay more than a nickle for that.

Probably didn’t even come with ice….

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And what are they talking about?

They obviously know each other well enough to invade personal space, so I suspect they aren’t discussing the latest technique in abdominoplasty.

Full hospital soap opera plot lines have been developed around less than you can imply from this ad!

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Let me clarify one thing.

This is not a “Men are from Alpha-Seti 5, Women are from K-PAX” issue.

Both sexes are represented in nursing and medicine.

This is about communication in a medical setting.

  • Telling a doctor something you believe they need to know about your patient.
  • Getting an order from a doctor for something you believe a patient needs.
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Here is what I have learned regarding communication with physicians, in any setting.

  • Unless your patient is dying, don’t interrupt.
    • This is Basic Manners 101
    • If the doctor is talking to a patient, another physician, a nurse or is in the middle of a dictation, try to wait until the conversation/dicatation is complete.
    • If the situation is urgent, approach the doctor, apologize for the interruption and state your concerns as succinctly as possible.
    • Remember, in the Emergency Department, while you, as the nurse may have a 3-4 patient (or more!) assignment, the ED doc has every patient in the department and is bombarded from all sides, just as you are. Patients, families, lab, radiology, primary doctors, hospitalists and even the Administration all want a piece of them. Sometimes ya just gotta wait your turn.
  • Have all pertinent information available when you call a doctor on the phone, such as from a med/surg unit.
    • If you know what you want from the doctor, ask for it directly. Examples would be restraint orders or additional pain medication before it is due.
    • Just calling and saying “there’s something wrong with Mr. Doe” will get you nowhere. Especially at 0400.
    • State the issue. Mr. Doe is confused, you suspect an adverse reaction to a medication, no urine output for 2 hours, new onset fever, Mr. Doe has chest pain, unrelieved abdominal pain etc.
    • Be sure you have done all that you have orders for before you place the call. If the patient has a prn order for Tylenol, give it. If IV Lasix is to be used for a low urine output, use it. If there are orders for blood cultures if fever > 101, do them, etc.
    • State what you have already tried to rectify the situation, if applicable. You gave Tylenol with no change, the prn Lasix did not work, everything was fine until 30 minutes after the little purple pill, blood and urine cultures are in progess, etc.
    • Be ready for questions
      • Have the patient’s chart in front of you.
      • This includes the medication record, the vital sign sheet, including the most recent set of vital signs (which should be taken just before you call), access to the lab work and a doctor’s order sheet to write down any new orders.
      • KNOW THE PATIENT
      • You may be speaking to an on-call doc who has no clue who your patient is. Be ready to give a brief history of the present illness, previous surgeries, etc.
        • Eyeball a dictated history and physical before you call or keep it in front of you.
        • If you don’t know the answer to a question or the information is not accessible to you, say so. Don’t try to explain around it.
  • Doctors are human.
    • Do not, under any circumstances, take anything said by a physician in the heat of the moment or at 0400 personally. You will hear four-letter words on occasion. They’re venting.
    • You will run across doctors who are angry, exhausted, sick themselves, half-asleep, exasperated, sad, mourning, or just plain stressed because this is their weekend call and they have been in surgery for 95% of the time and they just hit the bed when you called.
    • Cut them some slack.

(Yes, I know all the comments: they knew what they were getting into when they went into medicine, they get paid to get calls at 0400, yadda…yadda…yadda.

Give ’em a break, they earn every bit of that money and then some.

It took me a long time to see a “person” under that “MD”, but life will be much less stressful for you when you can.)

Now, what to do if you are confronted by an out-of-control, abusive, screaming physician? Male or female?

  • Understand that the odds of this occuring decrease with each year that passes. Doctors and nurses have a different relationship today.
  • While it is happening:
    • Stay calm – do not burst into tears or punch ’em in the nose. What is happening is not your fault (unless you have just backed into their BMW, then you got it coming!)
    • Stand upright and face the physician. Make eye contact.
    • Wait until the anger dissipates. It will.
    • Don’t yell back, in fact, drop your voice a few decibels.
    • Ask the doctor to step away with you to discuss why they are angry.
    • Acknowledge any error or lack of communication on your part that may have contributed to the situation at hand. This will deflate the anger faster than anything.
    • Do one of two things
      • Take a breather for a minute or two to get your adrenaline under control. Or, if you feel like you are going to lose it with either tears or retaliatory anger,
      • Get busy with something else ASAP
  • If it happens to a co-worker
    • Go stand next to them. Encourage others to do so, also.
    • It is really hard to be abusive to a person with a crowd of support around them.
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Now for those of you who are stuck in an OR with a possibly not-so-nice surgeon for hours on end, I have no advice, having no experience in that area. I will say that I have heard that neurosurgeons have a rather dismal reputation for OR ettiquette.Given the nature of the work, it’s probably understandable. But take heart, you neurosurgical nurses, I just read that Dr. Sanjay Gupta, MD,H.U.N.K of Time Magazine and CNN is now a board-certified neurosurgeon.

He can work on my central nervous system anytime….

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August 16, 2006, 12:50 am

Kate’s Fate: A Progressive Story

pinkribbon1 – Rita from MSSPNexus:
Kate stood, gazing up at the imposing glass and brick building silhouetted against the quickly darkening sky. The wind whipped her hair, and she absently pushed it back from her face. She watched as dark clouds rolled and tumbled ominously toward her, ravenously swallowing up the retreating azure sky. A single fat drop of cool rain landed on her cheek; she brushed it away like an errant tear.

It was time. She needed to move forward, to face whatever awaited her behind those glass doors. Yet even as that thought coalesced her feet remained motionless, as though mired in wet concrete instead of resting firmly atop it.

She had insisted on coming here alone, had been quite firm about the matter actually. Kate remembered the look on her husband’s face as he’d held her hand the night before and told her they’d face whatever the future held together. She’d squeezed his hand and smiled, “No need for anyone to make a fuss” she had said.

“What did you tell Amanda?” he had asked.

“I told her that a certain highly-placed official at Microsoft has decided to give Robert Scoble a run for his money and that I was jetting off to Seattle to meet with him about becoming a ghost-blogger.”

She grinned, remembering her husband’s laughter, and his request to see if she couldn’t snag a copy of Vista for him while she was there.

This morning she had kissed him on the cheek and breezed out the door as though she hadn’t a care in the world. To come here; to find out what comes next.

Kate began to walk briskly forward, toward her future.

2 – Me

Two days before, that Friday, she had seen her primary physician for a routine physical. Ironically, she had been able to schedule her yearly mammogram for late that same day. Thank goodness she didn’t have to take another day off of work. Things just seemed to pile up if she wasn’t there.

She caught sight of herself in the glass window as she passed. She looked at least ten years younger than she was. She jogged regularly and had the metabolism of a gazelle.

The epitome of a healthy woman and she felt every bit of it.

So she was just a bit concerned when her doctor called her after hours with the news that the latest mammogram was somewhat different than her previous film. Not to worry, the doctor told her, it might be nothing.

But it would require follow up. In the form of a biopsy.

She pushed the obvious into the depths of her subconscious.

Oh great, Kate thought, another day off of work. When did this need to be done?

Soon.

Monday.

Today.

And so it was that Kate found herself in front of St. Bernadette’s Health Center for Women.

She took one last look at herself in the glass door, smoothed out her skirt, threw back her hair…

…and prayed.

3 – Barbados Butterfly http://barbadosbutterfly.blogspot.com

Kate changed quickly into the white cotton gown, placing her clothes in a blue plastic bag before exiting the cubicle. Hurry up, she thought to herself. Let’s get this over with.

Kate was greeted by a rotund, flaxen-haired woman when she emerged. “Hi, Kate,” the woman said pleasantly. “I’m Jodie and I’ll be your ultrasonographer today. You’re having a biopsy of your right breast, yes?”

Kate opened her mouth to speak but ended up nodding instead as nervousness overwhelmed her. She followed the ultrasonographer into the room. A tall man wearing a white shirt and brilliant blue tie stood up from his chair when
she entered.

“Good morning Kate,” he said cheerfully. “I’m Dr Shand, one of the radiologists here. I’ll be performing your core biopsy today.”

Dr Shand explained the procedure. Kate nodded intermittently as he spoke, barely hearing a word. She understood that there would be a biopsy taken. She had no questions about what it involved.

“We won’t get the result of the biopsy today,” Dr Shand continued. “It will take 2-3 days to get a result and you will need to make an appointment with your physician to find out the results.”

Explanations over, soon Jodie was pressing the cold grey ultrasound probe against Kate’s breast, scanning for the abnormal area seen on the mammogram. The first needle was for the local anaesthetic; Kate stiffened as the needle
pierced her skin, trying to ignore the discomfort.

Kate glanced down as the radiologist brought the biopsy needle toward her, then quickly raised her gaze to the ceiling upon seeing the needle’s huge size.

“Snap!”

The loud noise of the biopsy needle firing made Kate jump. There was a burning pain within her breast. Kate stared at the ceiling and hoped it would be over soon.

4 – Dr Charles http://scienceblogs.com/drcharles

It was like déjà vu. She remembered the same piercing pain in her breasts ten years ago. Feeling inadequate and finally bowing to societal pressure, Kate had flown down to Miami to see the top cosmetic breast surgeon on the east coast. Make them big she had said. The surgeon had obeyed her command, and for ten years she had forgotten that pain, awash in the dubious glory of her new anatomy.

“I’m finding some strange resistance in the tissue,” Dr. Shand said. He looked worried. “I’ve never felt this sort of thing before.” With a look of concern Dr. Shand pulled out the anesthetic needle again. “I’m going to numb this up a little more and see if we can remove it.”

Kate felt the pain again, followed by numbness and tugging. “Dr. Shand, you know that I had breast implants, right?”

“Of course, of course,” he replied. “Wait a minute . . . Yes, I have it! Here it comes now, hold still.” Dr. Shand carefully withdrew his instrument from the core site. Stuck to the end of the puncturing tip was a piece of pale red tissue.

“What is that?” Kate asked.

Dr. Shand looked troubled. “This is very serious. Did you have your surgery in Florida by any chance?” He recalled that in the late 1980’s the field of cosmetic surgery was booming in Miami, and plastic surgeons from all over the world had set up shop. It got so out of control that licensing boards couldn’t keep up with the clinics or the credentials of the doctors. There had been one charlatan in particular who had forged his medical degree and training certificates, and eventually gained notoriety as one of the best surgeons in the land. But like all villains he had a dangerous hubris, a self-destructive streak that compelled him to sneak foreign objects into his surgeries and try to implant them.

Years later he was found out, tried, and locked away for life in Folsum County Prison.

“What is that?” Kate repeated desperately, still fearing that Dr. Shand was about to tell her that he had surely found cancer. The story that had begun with her abnormal mammogram was about to end tragically.

“Kate, I regret to inform you of a terrible thing that’s happened to you,” Dr. Shand said with all sincerity. “This piece of tissue was planted in you years ago without your knowledge. It is called . . .”

“What is it?!” Kate screamed, coming apart at the seams.

“There is no medical term for it. It is called Hubba Bubba.”

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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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