This post first appeared on Emergiblog back in March of 2006. Given that the theme of Grand Rounds this week is “Evidence Based Medicine”, I thought I would submit this post as a perfect example of how EBM affected my practice (and my personal life!).
The health coverage we’ve been waiting for!
$540 for hospital expenses for sickness or accident!
That just about covers your first hour.
$135 to your doctor!
This covers the first telephone consult with the hospitalist. Thank goodness! Your own doctor won’t be caring for you so it has to go to somebody!
Loss of work is up to $300! Well, for a nurse in the San Francisco Bay Area, that is a whole six hours! Ah….peace of mind!
And your life is worth $1000. Wow – I thought mine was valued at around $689.99.
It is not available for those over 70. Because you have, like, ten seconds to live.
War coverage is available.
Nah, I get that free on TV.
I am a compulsive nail biter.
When other babies were sucking their thumbs in the womb, I was bitting my nails off.
I’m not talkin’ itty bitty nibbles now and then. I’m talking down to the very last morsel and then peeling the rest to the cuticle, making sure it’s even, without any curves or stray pieces to distract me. My nails grow so fast, there is always something for me to “groom”.
I am sure this behavior is listed somewhere in the DSM-IV (or is it V now?) as an obsessive, compulsive, neurotic behavior with sociopathic overtones.
(Stay with me, this is going somewhere….)
And then I discovered the greatest invention of all time.
I am the only person on the face of the earth who got acrylic nails just to have their nails reach the end of their fingers.
There were times when my own nail remnant was so small they were glued onto the nailbed itself.
Finally, I had, dare I say it…..pretty hands! They grew so fast I actually had to have them redone once a week!
I was cured!
Then I blew it.
I opened my mouth to “Nurse Nasty”.
She trained under Florence Nightengale.
She was there in the Garden when Adam and Eve caught the first virus known to man.
She treated Fred Flintstone for gout.
Michael Crighton used her as a technical consultant when he wrote “Jurassic Park”.
One early morning after a horrifically busy shift in a horrifically busy ER known as “County Hospital Wannabe”, Nurse Nasty approached me with an ongoing issue. I was off the clock, but I had been Charge Nurse that night and my input was needed.
We had been working with a registry nurse who had fingernails two inches long from the end of her fingers. Two long, curved inches.
I’m sure she paid good money for them, but they looked obscene and how she managed to do patient care was a concern.
Nurse Nasty thought it would be best if Nurse Long-Nails didn’t return to the ER as long as she had what looked like ten lethal weapons on her hands. I agreed.
And then I made the fatal mistake.
I had to open my mouth.
I held out my hands with their tiny stubs of acrylics that just reached the ends of my fingers and said, “It will be a cold day in hell before I ever give up my nails.”
No one realized I had acrylics on my stubby fingers.
She wrote me up. Just for making the comment.
Off the clock, one woman to another.
She wanted my manager to know about my “insubordination” regarding the “new nail policy”.
I didn’t even know we had a nail policy!
The “new nail policy” was that acrylic nails were no longer allowed in hospitals.
I was more than angry.
I decided to research what was behind the policy.
I discovered that infection control officers in various hospitals around the country had traced groups of nosocomial infections to nurses with acrylic nails. Specifically, a pseudomonas outbreak in a nursery and a fungal infection in post-op bypass incisions.
I was allowed two weeks to let my acrylics grow out so that I could remove them.
And I did.
You can’t really argue with policies derived from evidence based medicine.
I’m pretty sure I could put them on again without anyone knowing now that I no longer work in that ER.
But I won’t.
I don’t want to be passing infections to my patients – the danger is bad enough without having ten bacterial incubation chambers on my hands.
…the very day I retire, you’ll find me in a nail salon, getting a full set of stubby little acrylic nails. Then again, I may even add an eighth of an inch, just for fun.