Sunday, September 29, 2013

The 0-10 pain scale, as my patients understand it

"My abdominal pain? It's a 10/10."




"The pain? Oh yea, it's about a 9... Can you come back when you have my medicine? I've got to finish this tweet."




Zzzzzzzzz... zzzzzzzzzzz... zzzzzzzzz... "Hey! Weren't you supposed to bring me more drugs? I have 10/10 pa..." zzzzzzzzz





"Well, I've had this cold for awhile. My sore throat is at least a 6 all the time, but when I cough it's definitely a 10/10."




"Only out of 10? Oh no girl, it's a 20."





"Don't... worry... about... me. It's only like a 3/10. I'm sure... you have... sicker... people... to help."


Tuesday, September 24, 2013

Patient's Words of Wisdom

"Only in the hospital do people come wake you up just to ask if you're sleeping."

Sunday, September 22, 2013

Who gets turned down?

Where I work, we get a lot of organ transplants. I love that patient population. They're my favorites actually. I think organ transplant is an amazing and miraculous advance of modern medicine. But organs are a scarce and precious commodity. Thus, there are rules in place that govern the allocation of organs and who gets a new organ. Not only does the potential recipient have to qualify medically under strict guidelines, but they also have to qualify from a psychosocial standpoint. This is to ensure that the scarce commodity that is that organ is not squandered. Being a transplant recipient is a lot of work, even and especially after being discharged from the hospital.

Mr. N is one of our recent kidney transplant recipients. Medically, he was an appropriate candidate for this new kidney. But the more I learned about him throughout his stay, I became more and more shocked that he qualified with his psychosocial background.
  1. He is illiterate. 
    • Literacy is important, especially for managing medication at home. Transplant medications are complex and the regimen must be follow strictly. 
  2. He is estranged from most of his family, including three ex-wives and multiple children who he's "cut out of his life." His visitors were restricted to the one daughter he was not estranged from and his girlfriend.
    • A recipient needs support, basically for life. Someone needs to be intimately aware of the potential complications that the patient faces, when to get the patient to the hospital, when to call a doctor, their medication regimen, etc, etc, etc. This takes on more importance when #1 is in play.
  3. He's homeless. He lost his trailer recently when it was foreclosed upon. He's been sleeping on couches and in his car. 
    • Maintaining health, especially after a transplant, is expensive. I'm inferring from this series of events that his financial portfolio isn't exactly sound. The concern here is that a transplant recipient's life-sustaining medications could fall to the wayside in lieu of other financial responsibilities. I've seen that happen with people who are much more financial stable. Direct path to rejection of said organ.
  4.  He might be going to jail. For reals. He'd been found guilty of a crime and is out on bail, awaiting sentencing. The way I understand it, he could get anything from probation to a 4 year jail sentence.
    • I feel like the problem with this one is pretty self-explanatory.

I realize that I sound like an elitist who is judging this man. I'm really not. I just want our transplants to succeed in the long term. Hard decisions need to be made to ensure the highest likelihood of success of the transplant. Tough love?

But my real question is, if this guy didn't get turned down... what's going on with guys who do get turned down?!

Saturday, September 21, 2013

I'm having a heart attack

Me: "Hello there sir. Did you call 911?"

Mr. Dextrocardia: "Yeaaa, I'm having a heart attack."

Me: "Oh ok... what's bothering you that you think you're having a heart attack?"

Mr. DC, vaguely gesturing towards his chest: "My heart hurts. It hurts real bad. You gotta give me something!"

Me: "Chest pain you say? Anything else bother you? Shortness of breath, nausea? Where is that pain located exactly?"

Mr. DC: "It hurts where my heart is!!"

Me: "So where? Show me where."

Mr. DC, pauses to think about this for a minute: "It's... uhhh... over here." Gestures to his right anterior chest. "Your heart is on the right... so that's where my pain is."

Me: "That's where your pain is or that's where your heart is?"

Mr. DC: "Both because your heart is on the right... right?"

Me: "Your heart is on the left... ish."

Mr. DC: "Oh well that's where my pain is. I forgot."

Oh sure. Let me draw up your fentanyl now. I bet you're "allergic" to nitro.

https://upload.wikimedia.org/wikipedia/commons/d/d7/Situs_inversus_chest_Nevit.jpg

Fun fact of the day: dextrocardia occurs in <1% of the population. Having dextrocardia without other other congenital defects is even more rare. I've seen it once. Pretty freaking cool.

Thursday, September 19, 2013

Hiccups

One of our patient has been struggling with hiccups ever since his surgery. Everything we've tried, medical tricks and home remedies (you know... pinch your nose, drink upside down, etc), failed to make them go away completely.

His PCP called to check on him the other night.

ring ring...

May: "Good evening, how can I help you?"

Dr. Exaggerate: "Good evening, this is Dr. E. I was just calling to check on my patient."

May: "Well sir, medically he's doing wonderfully. He is however, still struggling a bit with the hiccups."

Dr. Exaggerate: "Struggling?! He's damn near dying from them!!"


....... What's your specialty sir? I can introduce you to some dying patients if you'd like.

Wednesday, September 18, 2013

Who invented the call bell?

Pretend like before each minute marked, the call bell goes off and a nurse goes in and asks the patient what s/he can do to help him.

2127: "Before I go to sleep, can we rub some lotion on the back of my left shoulder? It feels a bit dry."

2136: "Can you scratch my nose?"

2138: "My nose still itches."

2144: "Can you scratch my forehead? The itch has moved from my nose to my forehead."

2147: "We should probably put lotion on my forehead now."

2155: "Am I dying?"

2158: "Does my gown need to touch me? I'd prefer it not touch me."

2204: "It's my eyelids now. They need lotion. Do you think we should just put lotion on my whole face?"

2209: "What if we call my wife, and she brings some rubbing alcohol in... Can she put rubbing alcohol on my face and back?"

2220: "I was just making sure you guys were still out there."

2230: "Do you think maybe we can clip my toenails tomorrow?"

2235: "Are you sure I'm not dying?"

2238: "How many types of blankets do you guys have? I don't know if I like this one."



It went on all night. With a break between about 2330 and 0155 and then again between 0330 and 0430. You'd think the sleep would help. It didn't.

Monday, September 9, 2013

Inappropriate

So Georgia, perhaps the sweetest and most innocent nurse I know, was taking care of Mr. B last night. He'd been in our unit for awhile with his infection secondary to IV drug abuse (clean needles people!) and his ensuing sepsis. We all had been taking turns falling on the proverbial sword because he was generally just a surly, rude and unfriendly guy. So last night was Georgia's turn.

They had an uneventful night, probably because Georgia is so nice and catered to his every whim. In the morning, she was helping him get up to the chair and he reached towards her chest. She thought he wanted to see her name on her ID and pulled it out to show him. Wrong.

Mr. B: "I don't want to see that."

Georgia: "Oh, ok, what do you want to see?"

Mr. B: "I'm trying to touch your titties."

Georgia, gets all flustered: "Mr. B! You can't do that!"

Mr. B: "I can do whatever the fuck I want. It's your job to make sure I'm happy. Get over here and let me touch them. I haven't gotten any since I've been stuck in here." 

Luckily, she left the room then. She was visible shaken and disturbed when she came and told me. She said that he asked her to bathe him next and that she wanted to say no. I of course told her not to do so. In fact, I didn't let her go back in for the rest of her shift. We assigned boys to that patient for the duration of his stay with us. Female employees who had to care for him used the buddy system while in his room. (This didn't stop him from repeatedly displaying his penis to said female employees on multiple occasions.) We told the story up the hierarchy to our manager and patient rep and nursing supervisor. But nothing came of it. He denied his behavior so it was "his word against hers." Classy. Clearly, we always want to err on the side of being warm and fuzzy to the patient. Way to stand up for the employees.

Now I realize I've previously posted a "funny story" about a delirious old guy commenting on my boobs. Double standard. So shoot me. It's a whole different ball game when the comments are coming from a 80-something year old, totally delirious and confused old man and a 40-something year old who's completely with it and has been an ass throughout his whole stay. Both are inappropriate, but there are gradations.

Are there any other professional scenarios outside of healthcare where the mentality is just "grin and bear it?" "It's not really their fault..." Consequences are just so rare for patients who abuse caregivers. In any other work-related scenario I can think of, the perpetrator has some sort of negative consequence. You look sidewise at a flight attendant and you risk getting thrown off that plane. Reach for a bartender's breasts and a bouncer will quickly be forcing you to get your drinks elsewhere. Most places of business reserve the right to refuse service to anyone. Our corporate institutions have lengthy sexual harassment policies. But healthcare providers can't kick someone out of the hospital. We are obliged to continue to care for the patient.

In my short years of being a nurse I've had a knife pulled on me, had a patient break my wrist, been thrown to the ground and strangled, endured more references to my breasts than I can remember and can't even count the number of pinches, scratches, bruises and bumps patients have doled out.

Now I know what you're going to say. I should have made a big deal out of some of these situations. And I'm sure I could have. In some circumstances, I considered the patient's disease at fault, not the patient themselves. (Except for the time my wrist was broken. I considered that to solely be the physicians' fault. Another story....) That's the overwhelming thought I believe. And one I support in some circumstances. But why do people think, in ANY circumstances, that hurting or harassing a caregiver is an appropriate response? Being scared and sick is terrible. But it's not an excuse to abuse me.

Saturday, September 7, 2013

Tip of the night: fake IDs

So imagine you're a nice 20 year old gentleman. And you just went to a fratastic party with you bros. And somehow, you end up separated from your bros. You just might think that the sidewalk looks pretty comfy and decide to sit down and take a nap up against a fence. Logical choice, but unfortunately, that makes passers-by worry about you and call 911. And then I show up. And a lovely police officer as well. Lucky you.

Now I've been doing this awhile and let me tell you, the officer really doesn't care that you're drunk. She has to run your ID in case you're wanted for murder in Arizona or something, but really she doesn't care. Unless you do something dumb that makes her have to care. And therein lies my patient's problem.

Officer: "Can I see your ID?"

Drunky McWasteface: hands over student ID (which has no birthday on it coincidentally)

Officer: "Great, thanks. How bout a driver's license?"

DMW: ponders this as he flips through his wallet. Hands over an out of state driver's license.

At this point, I glance down, mostly out of curiosity over the pretty, colorful out of state license. Then I come to the same conclusion the cop did. The IDs don't match. The brilliant young man gave her his REAL student ID and told her that was his name. And then gave her his FAKE ID with a totally different name on it.


Smart move dude. You just basically tied her hands to a pen and a ticket pad. You MADE her write you a ticket. She didn't want to get you in trouble. You begged for it.

Next time here's what you do...

1) Pretend you have no ID. She's not going to search you.
2) Claim you only have your student ID.
3) Give her your real driver's license. She really doesn't care that you're underage. Do you think she's an idiot? She's a cop in a college town.
4) Don't get drunk and sleep on the sidewalk, necessitating this entire interaction.
5) Actually pull off your fake. Rock it. McLovin did it.

All are viable options (except #5... don't try #5 with a real police officer). I'd really prefer you go with #4 though. Thanks! <3, A

Friday, September 6, 2013

I confuse the ambulance with a taxi too

So we get dispatched to one of the libraries on one of the college campuses in town. Call was for an 18 year old female with abdominal pain. As we arrive on scene, pulling up on the sidewalk in front of the library I noticed a young blonde girl skipping down the front stairs. She caught my eye because I feel like people rarely look happy and carefree at the library...

I get out of the truck and walk around gathering my jump bag and such to walk into the library in search of our patient. But then, much to my surprise, said blonde girl came around the side of the ambulance and scampered up into the back, settling in the captain chair in the back.

A: "Um, hi? Did you call us?"

Girl: "Yea I sure did!"

A: "Oh well ok... what's going on?"

Girl: "I have cramps. I don't feel like studying anymore."

A: "So you want to go to the ER...?"

Girl: "No! Why would I want to go to the ER just for my period? Just take me home... I'm done studying for the day."

A: blank stare "This is an ambulance. You called 911? We take sick people to the hospital."

Girl: "Oh well it's just a quick trip. I live in dorms just down the street. It won't take you very long."

Luckily the campus police walked up at this point and offered to take her home. I think the officer realized that if the conversation went on much longer she'd be investigating the patient's murder as I would have strangled her. Way more paperwork than just taking chickadee home.

Monday, September 2, 2013

Save the squirrels!!

Communications: "Truck 17 for the animal rescue, 293 Jefferson Ln."

Truck 17: "Truck 17 en route."

Communications: "Truck 17 you're en route to 293 Jefferson Ln for the animal rescue. Squirrel on a telephone pole."

This is when my ears perk up, and we decide it'd probably be worth it to mosey on over that way since we were just a few blocks away, on our way back from the hospital.

It gets even better...

Communications: "Truck 17 be advised, the caller reports that she's noticed a squirrel on top of the telephone pole outside her sorority house several days ago and that it won't come down. She's concerned about the animal's welfare."

How the dispatcher said that all without laughing and in a generally professional tone is beyond me.

The truck gets on scene and promptly clears the incident maybe 6 seconds after their arrival. We pull up 30 seconds later to all 4 guys off the truck, doubled over and crying they're laughing so hard.

The squirrel was obviously dead. Sorority girl, after being informed of this, told the truck's crew that they should get it down so she "didn't have to see the poor dead squirrel anymore." They responded with blank stares. 



Your tax dollars at work folks!