October, 2006 Archive

October 21, 2006, 3:21 pm

Notre Dame, Our Mother……

ndI need Ativan.


Oh my Lord, WE WON!

I think I’m going to friggin faint.

So this is what hyperventilation feels like!!!!!

Brady Quinn, you so freakin’ rock it isn’t even funny!

It wasn’t pretty, but it was WON!

I can’t sing, I’m hoarse, but don’t let it stop YOU!

Cheer, cheer for Old Notre Dame
Wake up the echoes cheering her name,
Send the volley cheer on high,
Shake down the thunder from the sky,
What though the odds be great or small
Old Notre Dame will win over all,
While her loyal sons are marching
Onward to Victory.

Oh my god…I’m wearing my jersey to work tonight, I swear I will!




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6:56 am

ER: Here to Save Your Derriere, Not Feed It

yeast flakes

So this is the secret!

You, too can be normal and charming!

Lord knows I need a truckload of this stuff.

Perhaps we can dispense it in the emergency department!

Here you go, Mr. Smith. This will make you normal and charming.

Side effects?

Well, your BMs will be regular and your skin will be flawless.

I wonder if yeast flakes help you “rise” to the occasion?

Has to be a lot cheaper than Viagra!


“I haven’t eaten all day”, he said. Approximately 8 packages of saltines lay open on the Mayo stand. “Get me something to eat.”

He’d been in the ER for all of 90 minutes; brought in by ambulance for “not feeling good”. Oh yeah, and the ubiquitous “nausea and vomiting”.

Hence the saltines.

He repeated the demand three different ways three different times in the sixty seconds it took to unhook him from his BP cuff and IV so he could go to the bathroom.

“I want a meal. I want a piece of toast and a cup of coffee.”

“Well, I can certainly try to get you some coffe….”

“Make it decaf.”


Now, I had worked my way through my first year of nursing school as a waitress, so I was no stranger to having someone place an order for food. Raising three teenagers just reinforced my ability to juggle multiple meal requests.

Only I’m not a waitress anymore. I’m a Registered Nurse.

He was a patient in an impacted ER on ambulance diversion.

He was neither destitute, nor homeless. He was neither debilitated nor emaciated.

He was alert, oriented and appropriately reponsive. He was older, not elderly.

He advised me that he couldn’t “hold his urine” and had peed through all the linen so his trip to the bathroom was preceeded by orders to change his linen after I obtained a pair of pajama pants for him.

Followed by another order. For a plate of pasta.


I’m pretty easy to get along with. If there is time and the patient requests it, I’ll jump on one foot three times around the gurney with party hat on, if it makes them happy.

I’m all about patient satisfaction. I will do everything in my power to make that trip to the ER as quick, as stress-free and as comfortable as I possible can.

But this was time for a bit of limit-setting.

Something in the tone. Something in the attitude. Something in this patient’s behavior hit my “now wait just a doggone minute” button.


“You and I need to come to an understanding here,” I said quietly but firmly as he returned from the bathroom.

“This an emergency department, not the local Denny’s. While I am happy to try and get you a cup of coffee, and decaf if I can, I am not a waitress, I am your nurse.”

That was all I said. In an even tone of voice. No sarcasm, no anger, no frustration

The patient didn’t make another request in the twenty minutes he had to wait before his transport to his in-patient room.

I’d have sent him up with a cup of decaf, except we were out.


My ER keeps a type of “box lunch” available for patients. These meals are primarily for those patients coming in with hypoglycemia. They must eat!

Patients who are homeless are offered meals. Patients who have to wait in the ER for their inpatients rooms are offered meals.

Usually it’s the family who comes out requesting a meal because “Auntie hasn’t eaten since breakfast.”

And it’s only 11:30 am.


While I understand the importance of nutrition in the healing process, let me make one very provocative, controversial statement:


Unless you are a diabetic, missing one meal is not going to hurt you.

There, I said it.


As far as I am concerned, food has a very limited place in the milieu of the emergency department. And so, I’d like to make the following observations.

  • Most ERs are equipped with saltines, milk and juice. If lucky, there are sandwiches available for those patients who require them.
  • If you come into the ER with abominal pain, nausea, vomiting or any potential surgical problem, you will NOT receive a meal.
  • We are sympathetic to the fact that you have not kept anything down in two days.
  • This does not automatically stop because you are in an ER.
  • What we WILL do is get your vomiting and nausea under control and offer you clear liquids.
  • Yes, we know you are hungry.
  • It IS possible to be nauseated and hungry at the same time. I’ve been there.
  • The hunger you are feeling will not kill you. The Double Whopper with Cheese complete with the “I’ll take fries with that” will hurt you.


The ER.

Its dedicated mission: to explore strange new symtoms.

To seek out diseases and life-threatening situations.

To boldly fight Death where Death has never been fought before.

Its prime directive is not, to quote the eminent philosopher Winnie-the-Pooh, to cure the rumblies in your tummblies.

So while your nurse may be happy to get what you request:

  • Make sure it is within reason.
  • Realize that in addition to your request for food, your nurse
  • is also working with 2-3 other patients
  • is giving medications with some potentially serious side effects
  • may be dealing with either imminent death or new-onset disability in the room next door.

Unfortunately, it isn’t all about your stomach.

And if you are like me, prolonging that meal by a couple of hours or missing a meal altogether, will NOT make you an emaciated version of Kate Moss.

After your discharge, you can always hit the local Taco Bell.

I’ll take a bean buritto with green sauce, extra cheese and onions.

Just in case you ever need to know.

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October 18, 2006, 5:27 pm

Change of Shift: Volume One, Number Nine


Welcome to the ninth edition of Change of Shift: A Nursing Blog Carnival! This week we have nurses from a variety of specialties plus a doctor, a pastor and a mom checking in!

Let’s get started!


Keith expresses amazement that we still haven’t learned how to help our new colleagues in Still Eating our Young? We need them too badly to lose them to what can seem so overwhelming that first year. And they need us to show them the way. Keith posts at Digital Doorway.

Cas presents a look at the emotional adaptability required after a patient codes in If These Stretchers Could Talk posted at Mommy Nurse Wife and 25!. Cassie doesn’t stop there. She presents some interesting modes of medication administration in Deep breath and PUFF . I know some ER staff who could benefit from this exhaustive study of what we so professionally call “Vitamin A”.

Fat Doctor presents a gut-wrenching story of what can happen when continutity of care is disrupted. The post is entitled Responsibility and is posted at Fat Doctor. It will make your heart ache.


Nurses often find themselves in situations not addressed in the textbooks. John discusses an unusual request by a patient’s family in To Pray or Not to Pray… posted at DisappearingJohn RN. Check out the comments section. How would you handle this?

Patients go through many stages as they learn to care for themselves when a chronic illness is involved. Sometimes the final motivation to success can come from an unexpected source. Janet at Chocolate and Raspberries shares an uplifting tale of success in It’s Time For the Happy Dance! Patient-run hemodialysis at home? Am I the only one who didn’t know that was possible?

Been there, seen that? I bet you have! Mother Jones, RN at Nurse Ratched’s Place talks about that always awkward situation The Workplace Romance. Although, if you are a pudgy, almost-50, married RN, no one will try to pick you up at Starbucks. Trust me on that one.


Master “juggler” and soon-to-be NICU Resource Nurse Laura observes the seemingly younger and younger physicians in Paging Dr. Doogie Howser over Adventures In Juggling. Let us not forget that although we nurses are aging, we are doing it quite elegantly, don’t you think?

Awesome Mom talks of a nurse she became particularly close to in Moments in the Night posted at The Adventures Of An Awesome (Sometimes) Mother. Sometimes caring for a patient can be a two-way street. Awesome Mom, you really are awesome.

John has a healthy respect for the legal requirements of nursing but doesn’t let it affect his patient care in Defensive Nursing. It’s one thing to know your profession and the legality thereof; it’s another spend every moment in fear of litigation. Posted at DisappearingJohn RN. Are you a “defensive” nurse?


Marisa may have already decided on a specialty! In Wound Care she describes her day with a wound care nurse. Posted at Nursing Student Hell, her enthusiasm make me want to consider the same thing!

Pixel RN is back with a vengeance! She gets to put her ACLS training to good use in My First Cardioversion. “In sync” is not just a boy band! Find out where Pixel’s been these last few weeks!

There’s a new ER nurse in town! Her name is Julie, she’s from Oregon and her blog is ER RN. In Honor of Halloween, she has penned a treacherous, frightening scenario of just what can happen in an emergency room on that night of all nights…….Welcome, Julie!


Our “other” Julie this week is our Julie from Life in the NHS who discusses the reasoning and some of the processes involved in Educating People In the NHS. Yes, there are issues, but until they are resolved there are patients to care for and work to do! Nice new look to the blog, too! Great job!

kt talks about being there for her patients and their family in My Job, My Pleasure. It really isn’t “all in a day’s work” for a nurse. There is so much more. It means so much more.

NeoNurseChic pays one last “visit” to her tiny charges in a touching post entitled My First NICU Memorial. It takes a lot to be an NICU nurse. The joy of success, the pain of loss. Both are described beautifully here.


oncRN references a recent New York Times article about the ramifications of what a DNR means and the suspicions surrounding the topic. In the post DNR, oncRN makes the observation that even in the world of oncology, death is a difficult topic to broach. She makes the case that the specialty of oncology should be a role model for acknowledging patient’s fears about death early in the process.

Susan, our volunteer ER Chaplain, makes many, many good “points” about why knitting needles are not a good idea in an ER waiting room. See Nix to the Knitting Needles. Susan, girlfriend, I am so on the same page with you! At Rickety Contrivances of Doing Good.


Thanks to all who participated in this edition of Change of Shift!

Next edition will be on November 2nd and we will have a guest host: Disappearing John!

Send your submissions to John at “disappearingjohn at gmail dot com” or through Blog Carnival. He’s looking forward to some great stories!

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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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