July, 2007 Archive

July 10, 2007, 11:32 am

The Literary Project: A Picture Is Worth a Thousand Words

It’s time for the Literary Project!

Thanks to Maria over at intueri, a group of medical bloggers have taken on the following challenge: write a story of no more than 1000 words using the photo below as inspiration.

I chose to go with a sort of sci-fi approach.

Isaac Asimov, eat your heart out!

(In my dreams!!!)

If you like it, I take all the credit. If not, I blame it on finishing the story after being up for 24 hours!

The title: ” A Picture is Worth a Thousand Words”.



Alecta sat with her head in her hands as her husband paced.

“Malec, please stop. Come, sit with me. The waiting is unbearable.”

“Do you really think it would be any easier if I were to be still? When will they tell us?” Malec ran his hand through his dark hair. “Why would this happen to us, to our baby? What did we do to deserve such a child as this?

“Oh Malec, how am I to know these things? I am confused, as you are.” Alecta sat up in her chair.” There was no warning, no foretelling! Are we to question the ways of the Maker?”

“I said nothing of the Maker, Alecta. I would not presume to question It. ” Malec peered through the window. The atmosphere was thick with transport vehicles. “We’ve been waiting for over eight timespaces. It cannot take this long to know the truth.”


Alecta had spotted Malec across the vast conference space during her technology indoctrination. He was striking in appearance, impressive in knowledge. It wasn’t likely that she would match his social level, so Alecta was surprised to discover that Malec resided in her sector. She introduced herself during a rest period, under the guise of asking a question on class materials.

Alecta and Malec petitioned for a Committment Document soon after their meeting. Following Sector Council approval, they petitioned for a Child Selection slot at the Department of Genetic Reproduction, or DGR.

They had reviewed their options carefully. Many of the Committed were choosing android children. They could fashion their child’s appearance and aptitude, plus modify personality traits. Alecta felt that to be a cold, impersonal relationship. She wanted her child to be a part of her, connected to her biologically. Her family unit had expanded in that fashion for millennia. Malec’s family unit, also. They were agreed.


When they were formed, DNA samples were taken from both Alecta and Malec and stored in the Department of Genetic Reproduction. Now that they had been given a Child Selection slot, they petitioned the Maker for a biological child. Their request was granted.

Unlike the parents of android children, they would have no say in the characteristics of their child. The Maker would combine their biological material in a way It deemed appropriate.


Alecta visited her child almost daily. Malec accompanied her frequently. Mechanical wombs were transparent and Alecta could see the other children as they developed. Something was different about her child. Others who had petitioned for a bio-child would peek over and look away or pretend not to notice. Her child was marked on the right side of the face. Alecta had never seen anything like it before. The maternity workers did not know what it was. Malec did not understand.


The Maker had chosen to give them a daughter. Malec chose to name her Prenya, which meant “chosen one” in his language. He carried a pictoral representation of her in his personal folder. He would show it to colleagues and friends, even strangers on the transitway. No one mentioned the mark.

One day an older woman was sitting near Malec when Prenya’s picture was presented. She took a fleeting glance at the picture, blanched and then slowly pulled the photo over to herself for a better look.

“Do you understand the meaning of this mark?” she asked, looking at Malec.

“No,” Malec replied. “Unusual, is it not? We do not know the purpose. Perhaps it is a genetic mutation.”

“Genetic mutations were curtailed thousands of years ago.” The woman said sternly. “The Maker does not produce mutations. Do you not read the Book? The Maker has given your daughter this mark for a reason.”

“What might that be?” responded Malec, beginning to feel annoyed. She was one who treated the Book as though it were the ultimate truth. That was so 2560’s! He was glad that he and Alecta were of the enlightened segment of society.

“If you do not already know, you will not believe an old woman,” she said. “The ancients once said, ‘a picture is worth a thousand words’. Perhaps the thousand words you seek are in the Book.”

Malec exited the transitway and promptly forgot the crazy woman’s words.


The time came for Prenya to be released from the mechanical womb that had been her home for thirty-nine weeks.

Alecta and Malec arrived at the Department for Genetic Reproduction ready to take their newly formed daughter to their habitat. They waited for their escort to the birthing chamber. Instead, they were introduced to two men in flowing robes. Alecta was stunned. She knew these were representatives of the Maker. Why were they talking to Malec in such serious tones? Why were they not taken to Prenya’s chamber?

“Malec, speak to me! What is happening?” she implored after the representatives had gone.

“Alecta, they think Prenya is the Chosen One,” Malec said quietly.

“The chosen wha……” Alecta stopped mid-sentence. The Book. The mark. The mark meant something, but what? She tried to recall passages memorized so many eras ago.

“The One chosen to lead, Alecta. The Queen. It was written that She would be known by Her mark. They are testing Prenya now.”


The door slid quietly open and the two representatives of the Maker stopped in front of Malec and Alecta.

“It has come to pass. The Queen has been formed by the Maker and is now claimed by the Maker as It’s successor. Your daughter bears the mark that was foretold in the Book. The Maker confirms her identity.”

“The mark will be seen as a sign of beauty throughout the ages and your daughter will be revered by our people. This is an honor bestowed upon you by the Maker. Queen Prenya is yours to raise and develop for eighteen time eras. She will then begin her reign as the Queen of the People.”


On the way to their habitat, Alecta and Malec tried to come to terms with what they had just learned.

“Raising Prenya is going to be such a responsibility,” noted Malec.

“Raising a child is always a large responsibility,” said Alecta. “But the old woman was right. Prenya’s picture was worth a thousand words. What we saw as a disfigurement was a sign of royalty.”

By the time Prenya was old enough to assume her role, it was also a sign of beauty.

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July 8, 2007, 6:44 pm

Help Me Help You


This picture has sort of a “Twilight Zone” feel to it.

I’m not sure if it’s the masks, but I get the feeling the baby is about to be taken for “indoctrination”.

Rod Serling is standing just out of camera range.

Then again, maybe it’s the perfect hair and make-up on the new mother.

Lord knows that would only happen in the Twilight Zone!


Nurses, here’s a chance to take care of each other and have some fun in the process. The idea comes from POPT over at Pixel One, Purl Two. The details are at Secret Pal For Nurses. I’m already signed up. Join the fun!


You read about the responsibilities of health care providers to their patients. Safety. Efficient service. Empathy. Confidentiality. Courtesy. Continuity of care.

What you rarely see are the responsibilities of patients to health care providers.

What exactly do the patients owe us?

The majority of readers are probably health care providers, but we are all patients at one time or another.

Here’s a look from both sides of the gurney.


The health care provider must provide safe, appropriate care.

  • The patient is responsible for giving a complete medical history along with an accurate medication list or bringing someone with them to the ER/appointment who does have that information.

The health care provider must provide efficient care in a timely manner.

  • The patient is responsible for being at their appointments on time. They are responsible for understanding that in an emergency department, there are no guarantees as to wait times, that sicker patients will be seen first and “sicker” is defined by the triage nurse/emergency staff. Most emergency rooms have this information posted on the walls. In two languages.

The health care provider must be able to empathize with the patient’s concerns/anxiety.

  • The patient is responsible for letting their health care provider know what they need – HCPs aren’t mind readers. They must also understand that there are other patients in the emergency department/office and that the time available to spend with a patient is finite.

The health care provider must protect the patient’s confidentiality.

  • The patient is responsible for staying in their room/area and not asking about the condition of other patients. They are also responsible for bringing only the necessary visitors with them and not the entire clan.

The health care provider must provide for continuity of care.

  • The patient is responsible for making the follow up appointments and keeping the appointments as advised. They are responsible for taking their medications as prescribed and informing their HCP of any problems/issues that will prevent that.

The health care provider must treat the patient with courtesy.

  • The patient is responsible for being able to give their undivided attention to the HCP during their exam. This means no cell phone or text messaging, no chatting with friends while the HCP is trying to interview you.


Good health care is a team effort. The patient is the reason for the team. The health care provider and the patient have a responsibility to contribute to productive interactions.

When the patient doesn’t understand their role in the health care environment, it is up to us to empower them, to let them know what they can expect and what is expected of them.

Patient empowerment. Another word for patient advocacy? Sounds like a nursing function to me, but all of us are patient advocates.

I guess all the above can be filed down to one concept.



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July 7, 2007, 1:25 am

Smack the IVAC!



That is one long stethoscope!

You could stand outside the room, throw in one end and listen from the hallway!

It’s been my experience that the longer the tubing, the less I am able to discern breath sounds.

I thought I was going deaf from too many rock concerts until I bought a more expensive stethoscope that is just barely long enough to go around my neck. Breath sounds were clearer. Heart sounds were clearer. No more of those cheapie Littmanns for me (that’s no dis of Littmann, my upgrade was the Littmann Master Cardiology).

My doc had a stethoscope that was electronic. I checked it out. $800! I would love to have it, but I have learned from painful experience that the more expensive the stethoscope, the more likely it is to “walk”.

I’ll treat myself to it someday when I figure out how to weld it to my body…


The Nursing Voices forum is off to a great start!

By popular demand, we have added categories for advance practice nurses and faculty/research. I know from my BSN classes that many nurses are going back to school to allieviate the shortage of nursing instructors so any expertise in teaching or research is greatly appreciated!

There are many new nurse bloggers and some are submitting to Change of Shift for the first time. Emergiblog is almost two years old and during that time there has been an explosion of nurses blogging on the internet. From the pioneers like Code Blog: Tales of a Nurse and Mediblogopathy to the new (to me!) nurse blogs like Counting Sheep and This Won’t Hurt a Bit.

Totally cool.


Emergency departments are noisy places. With all the people around hustling and bustling, you can’t even hear yourself think.

In the midst of all, you hear it.

Beep. Beep …….Beep.

Somewhere, somehow, someone conducted research to find the most obnoxious sound occurring at the precise interval at the perfect pitch to drive registered nurses out of their minds.

Then they installed it.

In the IVAC.


Some of my colleagues are highly sensitive to this repetitive warning that something is not right with an infusion. They can sense an alarm before the sound waves are even generated.

They sit straight up, head slightly tilted, muscles tense with anticipation of rapid deployment.


The machine does not make another sound.


I don’t ignore the alarm, I check out the problem. Downstream occlusion. Upstream occlusion. Whatever.

I don’t necessarily silence it when I’m trouble-shooting.

I probably should, just so my colleagues don’t think it is being ignored. For some reason it doesn’t drive me batty.


Now the alarm on the cardiac monitor is another thing altogether.

Our monitors sit high above the nurses’ station. It alarms. 99.99999% of the time it is artifact. But until the alarm is “silenced” by pushing a button it will ring. And ring. And ring. Not loudly. Not obnoxiously. Consistently, at a pitch that hits the brain just above the level of conscious thought.

Meaning it is easy to ignore once you have ascertained that there is no problem to address.

And so the game begins.

Three nurses and a doctor sitting under the monitor, which is making regular, persistent, mid-range hooting noises.

And no one moves.

A test of the will has begun.

Who can go the longest without “breaking” and silencing the electronic beast? Ironically, the same nurses who play “smack the IVAC” before it beeps twice are immune to the maniacal monitor monitone.

I usually win the contest because I push the repetitive noxious noise deep into my subconscious, causing fellow nurses to break before I do. Of course, if I’m sitting right under the monitor, one of my colleagues will politely ask me to please hit the damn BUTTON!

Huh? Oh! Sure…. (Tee hee! I win!)


Well, now they have made sure that the IVAC is audible to everyone and everything short of XM Satellite Radio.

Before you can open the machine to insert the IV tubing, you must conduct a “speaker test”. You press a button and a blast of sonic disturbance emanates from the infusion pump. Did you hear it? The machine asks you that! And if you did, and believe me you do, you must push the “Yes” button to continue.

(I wonder what happens if you push the “No” button?)

I know it’s for safety.

It’s also loud and obnoxious and another step in the ever increasing amount of minutiae we have to observe, document and perform each day.

So what else is new?


I’m using the term IVAC as a general name for an infusion pump. Not all infusion pumps are IVACs. We happen to use Baxter pumps, but that didn’t sound as good in the title!

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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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