This is NOT the Ritz

Hospitals, like pretty much every other industry, are becoming customer service driven. There's something to be said for that. I like nice people. I like it when nice people are nice to me. I especially like it when nice people are nice to me when I'm sick and feel like shit. But I want to go to the hospital that has the best doctors and nurses and staff, not the nicest. Hospitals are for medical problems. I've been quoted many times saying, "Dr. J is such an ass (he is), but he's the only one I'll let operate on me." That's because he's the best. Dr. J. could probably be nicer. It'd definitely make my life easier at times... But he's good at what he does and since he's a surgeon, whose job is to operate successfully, not be nice to me, I'll take it.

But thanks to the internet and the fact that half the world is fucking entitled, hospitals' reputations can be damaged by any idiot who can type. Newspapers love publishing shit like, "I was so cold and it took the nurses 15 minutes to bring me a blanket." Poor you, that's sad. The U is obviously a terrible hospital. You missed the part where the nurse, on her way to get said blanket, walked past the room where Grandma was trying to escape from her bed and about to fall and decided to prioritize that over immediately returning with your blanket. This makes my boss' boss' boss send me email likes "Today's employee goal of the day is: Smile at everyone in the elevator." I'd rather stab myself in the eye, thanks.

So last night my orientee, Georgia and I were taking care of Mr. Clog. He had an endovascular carotid stent placed, putting him in my ICU overnight. This procedure gets you an ICU admission post-procedure for q1 hour neuro checks for 12 hours and then you get to go home in the am. Angio to ICU to straight home. Rarely even go out to the floor. Which, pretty much by default, made Mr. Clog the least sick patient in our unit. He wasn't on oxygen. He had two PIVs... no central or arterial line. Yet he complained about everything. His IVs were "touching" him. He didn't like having cardiac monitoring leads on. But he slept most of the night and seemed to understand our explanations why he had to keep his leads on and IVs in.

So I was a little surprised in the morning when he started screaming at me and calling me a bitch. (Disclaimer: I have my moments, but I'm generally pretty nice to patients. Not top 10% on the nurse niceness scale, but definitely top quarter.) He asked for our manager and said he wanted to file a complaint. When I asked him what the problem was he said, "I come to the hospital to be pampered. Your only job is to pamper me and do everything I tell you to do. I didn't feel pampered last night and your manager should know that."

Seriously? Pampered? This is a hospital! This is NOT the Ritz. And I'm very highly trained at a lot of things that don't include pampering you, but keeping your sorry butt alive another day. (Also, an 60ish obese country white guy asking to be "pampered" is just weird in and of itself...)

Fat people have sex too?

So there was this obese women in the ER. And I'm talking like OBESE. I'd give her a rough BMI of 55? 60? Weight pushing 500lbs? This was a big girl. Luckily, along with her weight, she retained her sense of humor and was spending most of her time in the ER joking around (read: oversharing...) with the staff. Now mind you, this woman could not climb up onto the stretcher by herself and could not spread her legs independently for us to put a foley in. Yes, her thighs were so big that as far as she could spread her legs out to the side from the hip, they were still touching. It took eight nurses to put that foley in her, mostly holding her legs and pannus out of the way. EIGHT. That's another story in and of itself.

Ms Thighs: "You girls having trouble down there?"

Nurses: Grunt. Groan.

Ms Thighs: "Get in the gym girls. Cousin Thighs does this by herself."

Nurses: collective quizzical stare

Ms Thighs: "What? Oh you mean what's she doin' down there? Well once a month me and Mr Thighs like to have ourselves a nice night you know. Mr Thighs doesn't have enough hands to get up in there, so we pay my cousin $20 to make a little path for him."

O.M.G.

I love my cousins. I love my friends. I love my siblings. I love a lot of people. I don't love none of y'all bitches enough to hold your fat out of the way so you can get some. Not a chance. Not even with headphones and a HAZMAT suit.

That's where I keep my teeth

I was sitting at the nurse's station with our resident the other night; me stalking my orientee's charting, him flipping through a patient's paper chart.

Resident: "Ummmm... A? Is this normal?"

I look over and clipped into the paper chart, all nonchalantly, is a little plastic bag with two teeth in it. Two whole human teeth! No note, no nothing. Just oh, here you go, here's some teeth. Obviously. Where else would you store your spare molars?

Fruity Couscous

Add this one to the favorite recipes! I love this flavorful and textured couscous. This recipe was a hit! We all had multiple servings and I enjoyed it leftover too. Even the picky meat and potatoes only eaters gobbled it down. It's a great summer dish to make or take to work. The ratio of sweetness and vinegary-ness is perfect. And every so often there's a touch of sour from the apples. Perfection in a side dish!

Couscous:

• 2 tablespoons olive oil
• 2 cups Israeli couscous (or orzo)
• 4 cups chicken broth
• 1/4 cup chopped fresh flat-leaf parsley
• 1 1/2 tsp rosemary
• 1 tsp thyme
• 2 medium Granny Smith apples, diced
• 1 cup dried cranberries

Vinaigrette:

• 1/4 cup apple cider vinegar
• 2 tbsp maple syrup
• 1 tbsp salt
• 1/2 tsp freshly ground black pepper
• 1/4 cup olive oil

Heat olive oil in frying pan. Add couscous (or orzo as it were...). Cook over medium heat until grain is slightly browned and warm. Add chicken broth and bring to a boil. Turn heat back to medium-low and simmer for 10+ minutes, until liquid is absorbed. Set aside to cool. Once cooled, add fruit and spices. Toss well.

Meanwhile, in a separate bowl, combine vinegar, syrup and salt & pepper. Slowly whisk in olive oil until smooth. When couscous/orzo is cooled, toss with vinaigrette.

Overheard in the ghetto

Knock knock knock! "Rescue squad..."

Kylie, EMT extraordinaire, strolls in the door to the house, ready to save a life.

Six year old in his PJs, playing video games, without batting an eye: "Hey, yo girl. Show me your twat!"

........

Totally appropriate greeting.

Recipe: Slow Cooker Chicken Drumsticks in Asian Peanut Butter Sauce

Working mostly nights and the occasional day shift means that my internal sleeping clock is super screwed up. For example, one day last week I worked during the day and then was promptly so exhausted that I fell asleep at 730pm (before Jeopardy!) But then I woke up at o'dark thirty... or somewhere around 3am. I had been asleep 8 hours, so clearly was time to be awake. Then I proceeded to go back to sleep at 8am. See? Screwed up. So when I was wide awake on my day off at 4am, I needed something to do. What do you do at 4am? TV sucks at that time... so clearly, you should start cooking. I knew I would fall asleep eventually, so I looked through a blog I love: A Year of Slow Cooking. Shockingly, I wasn't in the mood for soup and was feeling something Asian-flavored... so I looked through her recipes that were tagged "Asian." I came across Asian Peanut Butter Pork, which she claims is delicious. She hasn't lied to me yet... and I already had most of the ingredients.







Nurses, doctors, and fire/EMS personnel are well known for their shift work and their ability (or reluctant requirement...) to switch back and forth between day shift and night shift. Throw a few 24 hour shifts in there. Whatever. So the crockpot can be (and SHOULD be) a shift worker's best friend.

Now, I'm not a big fan of pork. Never have been. My mom makes a world-renowned pork tenderloin that everyone raves about and I just won't eat it. Not really sure why. But obviously I wasn't too keen on making this recipe with pork. I thought the flavors would go well with chicken and I wanted something bone-in, so I decided to try some chicken drumsticks. Made a few other minor changes... but stuck with the essentials from the original recipe.

Maybe not the prettiest, but man does it taste good!

-10 chicken drumsticks
-1 red onion
-1/2 cup soy sauce
-1/2 cup brown sugar
-1 cup crunchy peanut butter
-1/3 cup apple cider vinegar
-1/3 cup water
-4 tbsp minced garlic

Cut the onion up into rings and place in the bottom of the crockpot. Put the chicken on top. Combine all the rest of the ingredients. Pour over top of the chicken. (Note: the peanut butter won't mix well with the other things... it's ok. Once it is warm and melty, it'll combine better.)

Cook on low for 8+ hours. (I think mine was in there for like 9 hours.) An hour or so before you're done, open up the crockpot and stir the liquid up. The peanut butter and other ingredients will mix right together.

Conclusion: Wow. Delicious. I gave it five stars. The chicken is so moist and succulent... it fall right off the bone. No knives needed at all. The peanut butter makes most of the flavor... kind of reminds you of a Pad Thai type of peanuty-ness. It's really good with rice noodles, which I had leftover. I'm sure it would be good with rice too. Definitely a keeper recipe. I don't think I would change a thing. Maybe a squirt of lime over top before eating. Oh and it's super filling... 2 drumsticks and I'm stuffed. Definitely a keeper recipe for your days off or for a nice 24 hour shift at the station.

Poop on the couch

I work with some brilliant colleagues. But we all have our moments right? And hindsight is certainly 20/20.

So there was this patient Mr Stool. He had a bit of the delirium. He tried to escape from his bed a lot. So sometimes he got a roll belt around his waist and his bed alarm was always on. (PS letting your patient fall is a big no-no. It makes managers yell at you and CNOs have small strokes. Oh and sometimes the patient breaks a hip... So we do many mean things to you while you're confused to keep you from falling.)

Well one morning, one of our esteemed nurses decided that in an attempt to placate Mr Stool and keep him from escaping, he'd offer him his choice of seats (this chair with the black seatbelt or that chair with the blue one...) Instead, Mr Stool wanted to sit on the little couch that's for visitors and families. 

"Hmmm..." thinks Nurse Vinny. "Well ok."

The couch is strategically missing the seatbelt that the chairs have, as our visitors rarely need seatbelts. So Mr Stool proceeded shit his brains out and I mean like the biggest amount of poop you can imagine being inside a human multiplied by 11. Since he was on the couch and therefore, sans seatbelt, Mr Stool basically created his own poopy slip 'n slide and wiggled himself right on to ground. Covered in poop.

Can't you just imagine walking in the room to give Mr Stool his am meds and instead find him on the floor covered in and surrounded by poop? Sucks to be that nurse.

HIPAA

I'm mildly terrified the HIPAA death squad is going to come hunt me down. So as a disclaimer, here is the list of eightteen identifiers that HIPAA considers protected. (Source: Department of Health and Human Services)


1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code

If you see any of these things on the blog... they've been altered from the patient or caregiver's true identity, if not fabricated entirely.

Take that HIPAA death squad!

Probably not the safest place to sleep

Communications: "Ambulance 41 for the unknown problem/man down. Intersection of This Street and That Road."

"41 en route."

"41, be advised, bystanders report that your patient was riding his bike down the street, stopped, set the bike down in the middle of the intersection and laid down on top of it. He appears to be sleeping."

He was, in fact, sleeping. With the assistance of a lot of alcohol. I don't know that I've ever be drunk enough to think that the middle of an intersection was a good spot to nap. Or to think my bike was a comfy pillow...