March 7, 2007, 3:31 pm

jazz-ER-cise

girdle

She needs a chin girdle?

Or maybe her girdle is so tight that it just pressurizes her upper torso and lifts her chin into her jaws.

No…wait…this is a wartime ad and Nurse Floppy Chin just feels she can do her job on the home front better when she is looking “smooth and sleek”.

Oh, and the thought of having to give up her foundation garments made her so scared!

What? Were they sending bras and girdles to the Pacific Theater? Were they using the girdles for sling-shots?

Maybe I’m losing my grip on history, but I thought it was “Bundles for Britain” and not “Bras for Britain”….

She’s so attached to these garments, she wears them at home under her frilly robe. With high heels!

*****

Well, I can say this.

The thought of having to give up my foundation garments would make me quite happy.

It should, however scare the heck out of you!

You’d be the one having to view the resulting spectacle!

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

exertionchart

As I mentioned yesterday, I’ve started Jazzercise.

The last time I did Jazzercise, it was in the mid ’80s and I was wearing leg warmers and french-cut leotards.

(Trust me guys, I didn’t look as good as it sounds….)

This is a picture of the Jazzercise “Perceived Exertion Chart”.

As I looked at the chart today in class (who knew there were muscles in your thighs?), I realized that a Jazzercise class was a lot like working in the Emergency Department.

*****

First we have the “warm up” segment:

  • You arrive in the department, put your purse/backpack/iPod/SpongeBob Squarepants lunchbox away (you were out of lunch bags and borrowed your kid’s).
  • You check the bulletin boards for new notices and snicker at the wise-cracks written on the margins of the new memos.
  • You pour yourself a cup of coffee just the way you like it!

You’ll never even get a sip.

The (eight hour) aerobic segment begins with you finding out you are down an RN and then receiving report from the off-going staff:

  • Four sets of family members are staring at you from their respective doors.
  • Now watch that Perceived Exertion Chart! You should still be in the “very-very light” range!

Time to increase the intensity just a bit! You go into each of your four patients’ rooms/cubicles/hallway beds and say hello.

  • Mrs. Smith is yelling at you with slurred speech and around an NG tube because she didn’t get the ice chips she “ordered” two hours ago and her pain is 27.2 out of 10 and when the H*** is her next shot?
  • Mr. Jones is asleep, but his daughter (the attorney) is writing down everything in a little book and asks “what was your name, by the way?”
  • Mr. Johnson is antsy because he has not been able to void in “three years” and he needs a catheter STAT!
  • Ms. Pierpont is a fetal position in a dark room, sunglasses in place and face in a bath basin heaving loud enough to be heard in Iraq and asking you to please remember that she is allergic to:
    • Toradol and Stadol,
    • Morphine, Dilaudid and Fentanyl
    • Vicodin and Percocet/Percodan
    • Phenergan, Compazine, Tigan, Reglan, Pepcid and Zofran.
    • And, just for the record the only thing she isn’t allergic to is, “oh you know, that other ‘D’ one.” Demerol! That’s it! Two-hundred milligrams of it to be exact. Intravenous. Nothing less will take her pain.

Feel the intensity rising! Good, now let’s take it up a notch now that we’ve reached “Fairly light”!

You feel the warmth of your increased pulse as you return to each room and:

  • Tell Mrs. Smith that as soon as she is able to finish a sentence without snoring you can give her more pain medicine and she is NPO because her bowel is so obstructed it is tied in a bow, so the ice chips are not coming! She rouses from her stupor just long enough to cuss at you before you leave.
  • Grab a foley catheter kit and insert it into Mr. Johnson ASAP because you know that urinary retention is extremely painful and hell hath no fury like a man who can’t void. Especially if it has been three years. Ah, he feels immediate relief and is extremely grateful to you, which is nice. He has 200ccs of residual urine in the bag. This means he has produced exactly 0.18cc of urine per day for “three years”. (And yes, I did the math.)
  • Mr. Jones is still asleep but his daughter (the attorney) wants to know where you obtained your degree, how long you have been a nurse, how many jobs you have held and where you were on the night of March 9, 1987.
  • Ms. Pierpont needs her pain medication, so you
    • Start an IV and begin 1000 ccs of normal saline for hydration.
    • When she asks for something for nausea, remind her that she is allergic to every anti-emetic known to mankind.
    • Give her the first of her Demerol injections via IV.

Ah, now your heart is really pumping, especially when you realize you are working with Dr. Ten-milligrams-of-Demerol at-a-pop and that Ms. Pierpont will be with your for a loooooong time. Oops, there goes her buzzer now! That first dose didn’t work, she told you that was going to happen! Ninety seconds and no relief! What were you thinking?

Uh oh, the wife of Mr. Johnson is staring at you! Why hasn’t he been discharged yet? And where is his leg bag? You grab the chart and print out detailed instructions for “Urinary Retention”, discuss those instructions with the patient and his wife and suggest that it probably isn’t good to wait “three years” before seeking help. Why no, he doesn’t have a urologist so you go print out a list of the local uro guys and gals and no, you aren’t sure who takes medical or who takes what insurance. Have a nice day!

Now you’re up to the “Somewhat hard” level but you know you can take it higher. You start to breathe a sigh of relief at one empty room when it happens! Code Three! Cardiac arrest!

Not your patient, but you start heading into the Resus room to help when you see Mr. Jones’ daughter (the attorney) standing in the doorway, arms crossed and foot tapping because her father has just had diarrhea and where is everybody because no one has checked her dad in an hour! The ER tech informs you that indeed, the patient is covered from the axillary level to his metacarpals in a Code Brown of mega-proportions. You and the tech clean him up. He sleeps through the whole thing.

Mrs. Smith is awake enough to ring her bell, and hurl a sling of outrageous foul language at you for taking so long to answer her light and dammit, she WILL have ice chips. Ding. Ding. Ms. Pierpont is ready for her third dose of Demerol now. Oh, and your charge nurse has just put a patient with vag bleeding and a possible miscarriage in the room just vacated by Mr. Johnson.

You are working “Hard” but still in the ideal aerobic range. Where you stay for the next six hours.

Finally, it’s time to warm down:

  • The next shift arrives and you give them report. You note that the family members in three rooms are staring at you and your colleague. Ms. Pierpont is ringing. Mrs. Smith just went upstairs and Mr. Jones has slept through another Code Brown, as per his daughter (the attorney) who is writing down the name of your colleague…..
  • You go over to the coffee you poured at the beginning of your workout, say good-bye to the mold that is waving to you as you pour it down the sink.
  • You go grab your purse/backpack/iPod/and the SpongeBob Squarepants lunchbox that you were never able to open that shift and head for your car.

You get home and dive into a nice hot bubble bath.

Congratulations on another good work-out!

8 Comments

  • ChiaLing81
    ChiaLing81

    March 7, 2007 at 4:18 pm

    Brilliant post. I have so much admiration for you ED nurses. I can’t even imagine being in such a fast-paced environment.


  • Carrie
    Carrie

    March 7, 2007 at 8:30 pm

    LOL Kim! I have learned that if I buy a hot chocolate or something as I’m going into the hospital, I will never get the chance to drink it! I’m always dumping it before I go home!! Oh and on the subject of caths for urinary retention…first of all, had to laugh at the 3 years thing! After I had my bilat knee surgery, they had me on morphine PCA, and I had a couple of side effects to it – one of which was urinary retention! I was throwing up because of how sick that was making me! They didn’t particularly want to cath me, but finally would do so when I’d keep puking and practically be in tears from being unable to void – each time they drained out over 1000cc! My mom describes me as a camel…so true…so true… That was awful, and prior to that, I don’t think I could have even imagined begging for a catheter, but I really wanted one then! lol

    I’ve had patients keep a little book full of every detail before. It always makes me nervous! The times I was in the hospital, my mom wrote everything down, but it was seriously just so that we knew what meds I was getting for our records, and also so that we could look things up and try to understand it more!

    I could never do what you do – I really did enjoy working in the ER and doing clinical rotation through the ER, but it was really exhausting and draining! I get tired from running around the NICU all day, but the ER is an entirely different ballgame! My calves are actually sore today, though, because I stayed for 3 extra hours last night…making it a 15 hour shift!

    Hugz,
    Carrie 🙂


  • […] My contribution for this edition equates a popular aerobic program with working in the emergency department. It’s called jazz-ER-cise. […]


  • Steve
    Steve

    March 7, 2007 at 11:34 pm

    Oh and don’t forget to talk with your supervisor about the nasty letter the hospital received about how you were sssoooooooo rude to a patient. Said patient verbally stated she was 2/10 pain and she had slight vag spotting. And then when the Gyn doc checked her; he guffawed and sent her home. But the mother of said patient felt the urge to vent her spleen about how rrrruuuuddddeeee everybody was to her wee wittle baby. And now the sup wants to know how she can get you to be more cordial to the patients.


  • Sean
    Sean

    March 8, 2007 at 1:38 am

    Possibly the Best. Post. Ever!


  • beth
    beth

    March 8, 2007 at 5:50 am

    Ha ha, I love this analogy. It made me think of what I would compare the MICU to…

    Pilates? countless small muscular movements but you might get the feeling you’re not really doing anything…

    Or when there’s very high acuity it’s like a spinning class; spinning your wheels for hours but never really getting anywhere.


  • zsr&j's mema
    zsr&j's mema

    March 8, 2007 at 9:31 pm

    Great story I admire ED nurses, I could never do it, but sometimes it is almost that bad on the floor. And those people who write everything down, I just want to go off on them don’t you. Later, mema


  • Phenergan » Blog Archive » Jazz-er-cise
    Phenergan » Blog Archive » Jazz-er-cise

    January 25, 2008 at 8:13 am

    […] […]


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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