November 9, 2009, 12:07 am

Domestic Violence – Did I Miss You?

spit:nursepostcard:zwerdling nursing archivesApparently once you remember that tuberculosis is spread by spitting…

You are then allowed to spit.

Reminds me of an incident.

Elderly lady.

Elegant, actually.

Didn’t speak English.

Smiled at everyone she passed.

She smiled at me.

Just before turning her head, clearing her throat and spitting three feet across the hallway.

Then she smiled and continued down to her husband’s room.

I didn’t take it personally. I did, however, feel my jaw hit the floor…

(Postcard courtesy of Michael Zwerdling, RN of the Zwerdling Nursing Archives.)


Emily over at really is CRZE this week! She’s doing Grand Rounds on Tuesday and Change of Shift on Thursday!

Help send her over the edge and get your CoS submissions in! You can send them to me and I’ll forward or send them directly to Emily at “emily at crzegrl dot net”.


Browsing through my October ENA Connection the other day, I noticed the theme was “Government and Advocacy”. Came across an article on domestic violence. It’s a short article, written by Carrie Norman, RN, CEN, member of the Government Affairs Committee. The quotes below are taken from Carrie’s article.

“The CDC estimates that 37 percent of women who sought emergency department care were victims of domestic violence.”

What? 37 out of every 100 women I have triaged?


“Domestic violence victims are more likely to seek treatment for chronic and psychological conditions.”

Okay. But no way have I been taking care of victims of domestic abuse – I mean, hello, wouldn’t it be obvious? The hovering, overbearing abuser who answers all the questions for the patient? The bruises that aren’t explained by the story?

You know, the stereotypical, classic scenario?

“The stress of physical/emotional abuse has been linked to many chronic conditions such as: chronic pain, fibromyalgia, frequent migraines and abdominal and gastrointestinal complaints.”

Well, yeah, I knew that.


I screen them, right? It’s part of triage.

Well, actually I check one of two boxes. Abuse: “Not suspected” or “Yes”.

And unless someone says “He/she hit me”, I check “Not suspected.”

What kind of a screening is that? How can you screen for a problem when you don’t even have to ask the question, you just have to “not suspect” it?


How many women have I missed?

When you came in for the fifth time in a month with abdominal pain for which no etiology could be found and for which you never sought follow up…

Did I miss you?

I’ll never know.

I didn’t ask.

When you presented with migraines on such a regular basis for so many years I got to know you like family…

Did I miss you?

I’ll never know.

I never asked.

When you sat in triage inconsolably sobbing over a skinned knee at 3:00 am because you “tripped in the garden”…

I missed you, didn’t I?

Because I never asked.


“Many women experience some form of violence in their home. I’m here to listen and I may have some suggestions to help.”

Hopefully, there is something we can do immediately.

Or, the patient may not be ready, may not feel it is a safe time to leave.

But, just having someone ask the question and offer resources for when she is ready can let her know she has options.

And give her a sense of empowerment to make the decisions she needs to make.

The bottom line?

Ask the question.

I am.

Should have been doing it all along.

November 3, 2009, 3:53 pm

The Need for Help Hits Close to Home

crime-sceneSam Nouv runs a little donut shop about a mile from my house.

When John was in the hospital, that’s where I bought the donuts for the nurses.

After immigrating to the U.S. from Cambodia in 1987, Sam started working at the shop and by 1990 he owned it (Update via Steve in comments: When he was 13, his parents were murdered by the Khmer Rouge. He spent several years in a displacement camp in Vietnam before finally being sent to the States as part of an entire plane load of orphans).

With the exception of a few holidays, Sam is in the store every morning at 3:30 am and works until 6:00 pm.

Seven days a week.

His wife, Lori, works with him, but she wasn’t there on that Wednesday morning in October.

Thank God.

Somewhere around 4:40 am, the donut shop was robbed. Sam was alone when the assailant entered the shop and he was pistol whipped so badly that he was rushed to Eden Medical Center for emergency surgery to have part of his ear reattached (Update from Steve in comments: “The pistol whipping was so bad that it not only almost severed one ear, but broke the occipital bones around one eye, severely damaged the other eye, and loosened his teeth so that it was more than three weeks before he could eat solid food).

After insurance, the bills for his surgery and health expenses could reach as high as $15,000. Pretty steep for someone who works 15-hour-days to make ends meet. Lori and the kids are trying to keep the shop going until Sam can recover enough to go back to his old schedule.

They need help.

Our friend, Steve Dimick, has helped set up a fund to help Sam and Lori to stay afloat as they deal with their upcoming medical bills. The full story can be found here, at the Castro Valley CARES! website.

Please consider hitting the “Donate” button – and anything, and I mean anything would be appreciated.

Castro Valley is a great community. My husband grew up there, works there and we live so close that it is my community, too. Please consider joining this community, if virtually, by helping Sam keep his business.

They say that charity begins at home. Well, this has hit extremely close to home.

And I want to help make it right.

October 29, 2009, 9:31 am

It’s Not WHAT You Say…

OffwhitelogoA ghoulish horror awaits you at Change of Shift, as Reality Rounds goes to the dark side.

I almost expect the zombies from “Thriller” to come dancing out of my den!


Read at your own risk!

Want to host? Contact me. I should come out of hiding in a few hours!


Zippy Must Be Free

A terrible injustice is being perpetrated against a very dear friend.

Zippy is being held hostage.

Dr. Rob told me about this at Blog World Expo.

We know where he is.

He’s been forced into areas of high radiation and indoctrinated with huge radiology books that would numb the mind of Einstein. He was forced to sleep with a crab! A crab that stole his lunch!

Now, I don’t want to name names (Vijay!), but Zippy must be free!

(Speaking of Dr. Rob, if anyone knows how to get a Golden Llama award, please email me. He treats those things like precious metals and I can only kiss so much of the ground he walks on, ya know. A girl has to have limits.)


The story of the nursing student who was expelled for blogging got me thinking.

(If you haven’t heard the story, check out What Can Nursing Students Blog About? at Code Blog, with an update at Kevin, MD)

Just what can you write about on your blog?

Well, you can write on just about any topic.

It’s not a case of what you say, it’s how you say it.


So how can you make sure that your blog post won’t get you fired (or expelled)?

Three things come to mind:

  • Blog about the issue.

Got a co-worker that is driving you nuts because they steal your Diet Pepsi from the fridge?  Got a manager that makes life hell? Tired of taking abuse from the “regular” drug-seeking patient who has called you fifty different names for a female dog?

Great! You have blogging material! But…instead of insulting the people involved (as tempting as that may be), make that blog post about respecting your co-worker’s space and property. Or the top five traits you think a manager should possess. Or how to stay cool in the face of verbal abuse.  Whether you use real or hypothetical examples to illustrate your point, make your point about the issue,  not the person.

  • Wait.

Did something good/bad/funny/sad/dumb/crazy/awful/miraculous happen on your shift?

As a blogger, you’re first thought is “whoa, I am so blogging about this!” And you can!


Let some time pass before blogging. This is prudent whether you blog anonymously or under your own name. Time gives perspective,  a chance to see underlying issues and an opportunity to keep emotions (and any inappropriate statements) in check.

  • Choose your words.

It is possible to blog about a difficult, sensitive or emotional topic and do it without being derogatory or insulting.  You can be humorous, sarcastic and over-the-top or angry, frustrated and at the end-of-your-rope and still convey an underlying sense of empathy and respect.

What is laughed at over a margarita after work is not necessarily appropriate for a blog.  What we post in a blog is a reflection of ourselves (and the nursing profession). Don’t just hit the keyboard in a blast of blogorrhea. Think about how your words will “sound” to someone else’s eyes.

If you do these things, I think you can pretty much blog about anything and everything without worrying about your blog bouncing back and biting you in the butt.

Because it’s not so much what you say…

…it’s how you say it.

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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog

Office of the National Nurse

Zippy Was Here

Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy