I'm Captain Jack!

Which Action Hero Would You Be? v. 2.0 created with QuizFarm.com

You scored as Captain Jack Sparrow Roguish,quick-witted, and incredibly lucky, Jack Sparrow is a pirate who sometimes ends up being a hero, against his better judgement. Captain Jack looks out for #1, but he can be counted on (usually) to do the right thing. He has an incredibly persuasive tongue, a mind that borders on genius or insanity, and an incredible talent for getting into trouble and getting out of it. Maybe it's brains, maybe it's genius, or maybe it's just plain luck. Or maybe a mixture of all three.

I Love My Job

...and no, for once I'm not being facetious. Today I got to do the following:

1) Remove two liters (that's 2,000 ccs) of pus from a nice man's bladder. He felt muuuuuch better after I was done. (The people in the next curtain, however, had to deal with the putrid smell while I was doing it. I felt bad for them.) He came in from a nursing home for "r/o UTI." He had a fever of 101.3. He also had a suprapubic catheter. His bladder was distended and painful. No urine was in his leg bag. I tried to irrigate his suprapubic catheter to no avail. So (per urology) I inserted a very thin catheter up his penis (a 14 French, if you're counting) and got a little spurt of thick, yellow goo. So I aspirated with a 60 cc syringe. And frank yellow pus came out. I kept at it, and after about a liter, I started getting pus mixed with blood clots mixed with amber, dark, foul urine. It was completely gross and yet totally satisfying, especially since the man went from moaning in pain to almost asleep and comfortable by the time I was done.

2) Get to have the following conversation with a cute, young, male, clueless resident about the next step with the above patient:

Me: So, should we set up some bladder irrigation to get that pus out?

Cute Male Resident: Yes, definitely. Let’s have a three-way.

Me: (snicker) Ah, a three-way. Sounds good! But how could we do it? Through the suprapubic? Through the penis? Both?

Cute Male Resident: Hmmm...Maybe a modified three-way?

Interested ED Attending in a Group That Is Laughing While Eavesdropping: What’s a modified three-way?

Me: A man, a woman, and...a transsexual?

(Note for the un-medical: the resident was referring to a three-way catheter used for continuous bladder irrigation--it’s a tube with three lumens: one lumen for irrigation fluid, one to carry the fluid out to a collection bag, and one that is used to inflate the balloon that keeps the catheter in the bladder. Note for the medical: We ended up setting up a “one way”: I inserted a new suprapubic catheter and a Foley cath. We ran the irrigation fluid through the suprapubic catheter and drained it out of the Foley. It was fun.)

An Addendum

So remember the people in my post And Now a Word From the Tourism Board? We finally found out what it was, exactly, that they took.

A little pot, a little coke, and a little formaldehyde. Straight. Apparently they were drinking it out of little glass bottles.

Happy Thanksgiving!

DR is going to his family's Thanksgiving dinner, and I'll be working. Not so bad, actually, if it's anything like last year. Besides--who can pass up 12 hours of work at time and a half?

The hospital cafeteria offers a free turkey and trimmings dinner to all who are interested; it's not great, but it's not terrible. Better are the dinners that some of the volunteer ambulance companies bring! YUM! Last year, Hatzolah brought us a deeelicious juicy turkey, complete with stuffing and potatoes and pie! That was pretty good.

Last year was not too awful (I'm refusing to use the Q word here), and the people we actually had really needed our help, which was a refreshing change. We'll see how it goes. The only bad thing is that I'm going to be the only relief nurse on, which means I'll be hopping around like a one-legged man in an ass-kicking contest.

I'm also working the next day, which could be good, if it's still holiday-slow, but could be REALLY BAD if it's like a typical day-after-a-holiday day. Oh well, it's just one day. Then we're going to drive to my Dad's for belated Thanksgiving dinner there. Dad is a chef, so I always look forward to meals at his place--and he's going to show me his brand-new professional double-oven stove he just had installed in his home kitchen. Woohoo!

So, this year I'm thankful for:

-Having a nice roof over my head
-Having a job that I actually enjoy most of the time that allows me to put that roof there
-Being in great mental and physical health (well, I could lose a little weight, but who couldn't?)
-And, believe it or not, I'm actually thankful for the mixed blessing of family, both immediate and extended.
-Of course, last but not least, I'm most thankful for my honeybunch. I'm the luckiest gal in the world.

Would you like fries with your sense of entitlement?

I was relieving one of my coworkers for lunch the other day. He and I were doing walking rounds down the aisle of curtains where his eight patients were, talking softly about what needed to be done for each person. In a bed two curtains down from where we were, one of our "intractable back pain" frequent flyers was holding court in her usual spot. Her family was seated all around her, taking up all the available chairs, and they were all dining on Chinese fried chicken wings and pork fried rice. We paused so we could listen to what they were talking about.

"I's thirsty," one relative said. "I'm getting some water." The pantry, where water and an ice machine are available to everyone, was no more than three yards from where they were.

Replied the Queen of Back Pain: "Never mind that. Where's that damn nurse? He's spozed to be waitin' on me. Go get him to get you some water."

did you skip 7th grade health class?

Thirty-seven-year-old, well-dressed, middle-class-looking woman comes into triage stating that she has been bleeding vaginally and experiencing some abdominal cramping since that morning.

The first day of her last period was thirty days ago.

Can you put two and two together?

I knew that you could.

However, I had to explain it to her. Twice. With a calendar.

Bug in a Bed II

Yesterday I went into a room to help one of our orientees start a line on a patient much like the one below, but this one was only contracted on one side and was flailing around with his other arm and leg. He was also vocalizing VERY loudly: "ARRRR! AAAAAAAARRRRRRRRR!!!! ARRRRRRRRRRRR! AR AR AR ARRRRRRRRRRRHHH!" Just then, the doctor walked in and heard what the patient was yelling. He looked at us, smiled, and said, totally deadpan:

"Well, shiver me timbers, mateys!"

I'll take Things That Are Gross for a Zillion, Alex

The triage paper said, "Sent from NH [nursing home, not New Hampshire] for evaluation of foot wound and r/o sepsis." The nursing home paperwork was at the doctors' station, and I was too lazy to go over there and get it, so I gloved up and went into the patient's room.

The patient was a typical example of what I call "a bug in a bed": A very old person of indeterminate gender, who responds only to painful stimuli, with the majority of limbs contracted so badly that it's nearly impossible to move them, curled up in an almost fetal position under the covers--kind of like one of those roly-poly potato bugs that curl up when you poke them. You know, mouth like an “O,” Crypt-Keeper fluff for hair, PEG feeding tube, awful pressure sores.

I began the usual preparations for a septic workup (IV line, bloods, cultures, Foley catheter) and started wrestling with the patient’s contracted limbs. These patients are a lot heavier than they look because they’re...well, almost-dead weight. As usual, the “vocalizations” began as I moved the patient around, a constant, “LAWD LAWD LAWD LAWD LAWD LAWD” at a surprising volume.

OK, time to make my way to the “foot wound,” which was under layers and layers and layers of gauze dressing. The unmistakable scent of gangrene started to waft delightfully out as I removed the coverings. It looked as if the dressings had never been changed--just added to, since they were full of dried secretions and goo and...some kind of...weird little...nugget-type thing? Some skin? Wha? What IS that? Oh, SHIT! Is that a TOENAIL?

Yeah. While removing the dressings, I also...removed the patient’s gangrenous pinky toe.

(Added Edit: When DR read this, he said, "WHY did you make me read this?!? Now I'm going to puke!" Hee hee hee. Maybe the dogs will take care of it.

Where exactly are those kids going?

Sorry for so many non-nursing-type posts, but this was awesome. Hat tip to Frugal Fag. (See the original post for his comments!)

Ewwww x 3

I made a Japanese curry beef stew in the crockpot last week. It didn't come out so great, so no recipes for you. I took some to work for lunch a couple days, and then it sat in the fridge. Last night Doc Rock was cleaning out the fridge and decided to give the leftovers (mostly carrots and chunks of potatoes) to the dogs with their dinners.

This morning as I was lazily drinking coffee and perusing my favorite blogs at the kitchen table, Big Dog came over, leaned against my leg, and started making that toilet-plunger noise that indicates puke is imminent. Up came the carrots and potatoes--completely undigested. Ew. Reassured dog, cleaned up puke. Medium Dog came over, sniffed the spot, and went into the living room. Two seconds later (on the RUG!!!), another little pile of potatoes and carrots. Cleaned that up, grabbed the computer and my coffee, and made my way to the couch.

And put my foot right in a wet spot between the coffee table and the couch. Double Ew. And it was just wet--no pile of potatoes and carrots.

So, at some point before I got up today, one dog puked there, and one dog ate the puke. Probably Medium Dog did the puke, but not sure which one ate it. Triple Ewwwwww.

Cake or Death?

Cake, please! With thanks to Dr Shroom.

Aaaaaahh...couches are nice.

Ahhh...my first day off after three days of 12-hour shifts in a row. It's really nice to sit on the couch and eat some nice food and catch up with my blog reading. DR wasn't feeling so well, so I made him some yummy pastina. Here's the recipe if you're interested (makes two servings or one big one):

2 cups good chicken stock (if using canned broth, omit the salt below)
1/2 teaspoon salt
1 cup pastina (little bitty star-shaped pasta)
2 teaspoons butter
2 tablespoons grated Parmesan cheese

Bring the chicken stock and the salt to a boil. Add the pastina, and cook, stirring occasionally, for five minutes, or until most of the liquid is absorbed. Place one teaspoon of butter in each of two bowls; divide the pastina between the two bowls and sprinkle the Parmesan on top, one tablespoon on each bowl. Mix well, and enjoy on the couch with a DVD. Or a dog. Or your honeybunch.

Paramedic Guilt

One of my favorite paramedics is a guy I'll call B. He's cute, very sweet, considerate, and smart as a whip. Really knows his paramedic bizness. He even brought me Vitamin Water once when I said I was feeling under the weather. That was super nice.

The other day he came in with a patient and he looked unhappy. He said he was tired, that it had been a long, bad day of traveling around at high speeds all over town to hospitals in all sorts of neighborhoods, that he was completely beat. And he looked it. Definitely not his usual smiley self.

Then he said it was really exhausting to bring in a patient and have all the medical staff look at him and his partner like they are lepers, to hear nurses suck their teeth when he rolls by with another patient on a stretcher, to hear, "Oh my god, ANOTHER ONE" every time they come in. He said he's tired of being the messenger who gets killed just for doing his job.

Whoa. I am totally guilty of doing everything I just described above. So, all you paramedics and EMTs and other emergency personnel: I am truly sorry for all the times I've waved at you as you've left the ED and said, "OK, never come back now! Ha ha ha!" I'm sorry for being cranky at you when I'm the ambulance triage nurse and am having a hard time finding beds for all the patients who are lining up down the hall for triage. I certainly can empathize with feeling like the killed messenger: I get plenty of flack from the nurses when I start doubling up beds in their areas due to high volume--it's one of the reasons I hate working ambulance triage.

Most of you are great at your jobs and are nice people too! You have great stories and dark senses of humor, and we generally get along well. So next time I'll think twice before making a smart-ass remark or glaring at you when I'm in a bad mood.

Love (xoxoxoxo),

GuitarGirlRN

Ass-Shakin' Good Time!

DR and I have been going to a lot of shows lately. Here’s some notes!

We paid a bunch of dough to see the Raspberries, and it was fun, but not as great as I expected. The sound was not fantastic; it seemed to get better as the sound guy learned to cope with the room--but seriously, for the money? Should have been perfect right away. The drums sounded like the drums at a guitar convention in California.

They did all of their power-pop 70s hits, like “Go All the Way,” “I Wanna Be With You,” and “Tonight,” but DR mentioned that he wanted to hear “less Beatles and more Who”-influenced stuff. I agreed. On a more positive note, the vocal harmonies were all spot-on and awesome; and the guitars were all beeeeeYOUtiful vintage instruments that both of us were drooling over.

The worst part, though, was when an overly botoxed and lifted Eric Carmen (seriously--his eyebrows were up in his hairline and his eyes probably don’t close all the way when he blinks) did his non-Raspberries hit, “All By Myself.” You know the one: it goes, “aaaaaaaalllllll byyyyyyyy myyyyyyyy seeeeeeeehehhhhheeeeelllffff.......don’t wanna be......aaaaaaaalllllll byyyyyyyy myyyyyyyy seeeeeeeehehhhhheeeeelllfff ...... anymoooooooooooooore.....” Not that I don’t like the song; it just didn’t belong in the Raspberries’ set. He excused this by saying he had written it just before they broke up and if they hadn’t, it would have been a Raspberries song. Whatever. At least he didn’t do his 80s hit “She’s Like the Wind” from the soundtrack to the movie Dirty Dancing. I think I would have rolled on the floor crying and kicking my feet like a three-year-old. Oh yeah--and old dudes with skinny-ass chests should NOT wear shirts with the top five buttons open. Ew.

Then we went to Cavestomp, “The Garage Rock Festacular!” It was a three-night event, but we only went to the last one (the tickets were expensive and we really only wanted to see the Sonics--more about them in a sec). It was held at a club that is inside (or rather part of) the Polish National Home. (A gazillion years ago, I used to do a union gig with the Polish Dance Ensemble that was based there.) It’s a very interesting place, with its big, boomy, basketball-court-like concert space, its strange Polish-mafia-looking bouncer/security guys, its retro bar complete with TV screens showing the action on stage and the sound piped in from the sound board, and its AWESOME food concession. This is a room off the bar staffed by a 70ish lady decked out in fingerless lace gloves, a halter top with rhinestone detailing, and skin-tight pants. For $5 a plate, she’ll serve you homemade Polish food! Mmmmm....I loves me some garage rock n kielbasa. And pierogies! The other patrons are also interesting: a nice mix of old timers, not-so-old timers (like me and DR), snooty hipsters, and what DR and I call "the 12-year-olds." These are the kids who look barely old enough to drive, let alone know what the Black Flag tattoo on the back of their neck really means.

There were five bands playing that night, but we got there in time to see the Lyres. The lead singer was great, banging away on a Hammond B3, flailing around and shakin' his tambourine like an evangelist in a gospel choir. Next were the Fleshtones who always put on a great show; not to mention they end every song like they’re ending the set (“as it should be!” says DR). And finally, rounding out the evening, the reincarnation of the Sonics, 60s-era garage-rock proto-punk kings (most people know their songs “Psycho,” “The Witch,” and, most famously, “Have Love, Will Travel,” featured in a Land Rover commercial). They reportedly got back together after like forty years to play these two shows. They were great! They had to take short breaks between songs to catch their breath (the lead singer/keyboard player has had a heart transplant as well as some kidney issues but still manages to do his WAAAAAAH!! Little Richard shriek in all the right places), but they all looked like they were having an amazing time. The guitar sound was unbelievable--it cut through everything. DR and I both walked out of there with our ears ringing and hissing, but it was worth it. Definitely an ass-shakin’ good time all around.

Pain Scales

Note: I originally started writing this post around October 26, the date of the blog linked below. Just so ya know!

Just catching up with some of my favorite blogs after work tonight and this one from Scalpel or Sword? really hit home.

As someone who has to deal with the "1-10" pain scale on a daily basis, it's true: Many times, it doesn't work at all. Take, for example, a totally normal, non-drug-seeking patient: DR, my husband. He gets occasional spasmodic muscular back pain, sometimes brought on by stress, sometimes by lifting heavy things, and sometimes because he is...well...not svelte.

The first few times his back seized up, I tried to evaluate his pain level on a 0-10 scale. "Honey, on a scale of zero to ten, where zero is no pain and ten is the worst pain you can imagine, can you rate your pain?" His response was (as he stood frozen like a statue, clutching his middle back and panting) "What? Are you kidding me? Uh, okay, zero stands for what? Can't I just say it really hurts? It REALLY HURTS!!" He really didn't get it. He couldn't relate to the numbers at all. I actually dug up a copy of the "Ouchers Scale" from a pediatric textbook (see link; it's for kids and uses photos of children's faces instead of just numbers). He managed to pick a face from that, but he picked a less-painful face (around 5) than what I was seeing in him (I would have placed his pain somewhere around 8 or so).

He asked me later, when he had less pain, what a pain score of 10 was supposed to feel like. I told him that some people phrase it as "The worst pain you can imagine," like being burned alive (some people say like childbirth). Some say "The worst pain you've ever had." Both of these are inaccurate: I can imagine that being burned alive would be pretty bad, but then I would probably be unconscious from the pain, so is that a 10? Does the patient have to be unconscious? And the "worst pain" some people have ever had is a stubbed toe.

Years ago, I had a bone-impacted wisdom tooth with a bone cyst under it. It was causing me a lot of swelling to my jaw and enough pain that I was taking ibuprofen regularly to control it. My dentist and oral surgeon recommended that it come out and that the cyst under it be cleaned out. This was not going to be a routine extraction, the surgeon explained. (As a matter of fact, his actual words were, "Well, we're going to mess you up good!") It was done under general anesthesia, I was intubated to protect my airway (it's very weird when they take that tube out when you're waking up--I only remembered it days later), and I spent quite some time in the "recovery room" of my surgeon's office until my mother could come take me home. Once home, I began taking the pain meds the surgeon had prescribed immediately, but, due to a mix-up at the pharmacy (read: the complete incompetence of the pharmacist) I had been given the generic of the meds, and not the brand-name, as specified by the surgeon (apparently it DOES make a difference--and how!).

As the local anesthesia I had been given started to wear off, it was as if a fire was starting in my face, neck, and head. I remember thinking, "how bad could it be? I'm sure the meds will kick in at any time now." Then the pain began to grow...and grow...and grow. Tears were streaming down my face, my shoulders were up around my ears, the pain was incredible--and so was my anxiety level. I remember being frantic, feeling like there was nothing I could do to "get away" from the pain. I couldn't breathe, I couldn't move, I couldn't speak: I couldn't think about anything other than trying to escape. My mom (also a nurse) actually said to me, "On a scale of one through ten.." and I remember yelling (well, not yelling...more like mumbling forcefully through my stitches) "TWENTY FIVE!"

Eventually we got the meds issue figured out, and I got some relief. The pain never went away (as it wouldn't for close to a week), but it was...diminished. What I remember is that I cared less about it; it was there, but didn't cause me the panic I was feeling before. That's something I share with my patients who are having pain when I give them narcotics; I say, "This will help you; it may not take ALL the pain away, but it will make you care less about your pain; you'll feel removed from it."

I've had people with terrible injuries or kidney stones or other painful conditions be writhing around and crying and miserable and rate their pain as a 5 (which qualifies for a Percocet, according to the guidelines in our hospital). I've had people who wake up from a deep sleep and yawn and rate their pain as a 10 (which qualifies for intravenous narcotics) . Admittedly, acute pain is different than chronic pain. I've also had people who are crying and writhing around who I don't believe for one minute are having any significant pain at all. And then there are the people who believe they should never have to tolerate ANY pain at ALL, EVER. Which is just not realistic.

What it comes down to is this: JCAHO feels the need to monitor our care of our patients, and the numbers scale allows them to do so. It's annoying.

Change of Shift is up!

Woohoo! And it's the first one I've ever submitted to. Yay, me!