Archive for October, 2009

When Pumpkins Drink

Pumpkins

Happy Halloween.

And have pity. I’m working tonight.

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Lo, a Compliment

I survived, though admittedly with an easy assignment — and thankfully I was nowhere near the triage desk. The emerg was actually pretty good last night. Anecdotally speaking, it seemed there was lots of r/o  influenza, but very little of the usual emergency department silliness. Maybe people are getting the message to stay out emergency unless things are dire?

Compliments, which any emergency RN will tell you, are few and far between, and are always viewed with a very large grain of salt. “You’re the best nurse I’ve ever had,” usually translates into “I want something from you” or something equally as manipulative. But I was discharging this patient last night, with whom I spent a lot of time doing health teaching, explaining the care plan, and reassuring, and as he was leaving, he said, “You are the best nurse I have ever dealt with. You are really good.”

I was so taken aback, I was left speechless. No mean feat. I don’t do compliments well, especially from patients.  And genuine compliments are generally rare birds. Being older and cynical, I’ll take what I can get.

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H1N1 Hysteria

Is this really helpful?

sun0

Or this?

sun1

Or this?

star1

Or this?

hspectator1

Or this?

citizen1

Or this?

ch1

Just asking.

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Being Sick or Being Guilty

Still at home with my ILI, but my spies at Acme Regional’s emergency tell me they saw 85 patients during the day shift, and a little over half of them complaints on the variation of “fever and cough.” And Occ Health has decided making its employees wait three hours in a rainstorm for their H1N1 at the public clinics was a bad idea, bad for morale and quite possibly bad for your employees’ health — hey, what could possibly be better than gathering in a cold rain with a lot of potentially sick people — so they decided to cough up (so to speak) some vaccine, and actually started needling some nurses.

But enough of my workplace. I’m a bit better, and am deciding whether to show for Nights tonight.  Six nurses are now out with the flu from our unit alone — all of them seniors including me — so staffing charge and triage and the resus room is beginning to be an issue.

There is no feeling like the fine, lovely, and compelling nursing guilt that comes from a sense of letting your colleagues down. Which is why so many of us idiotically drag ass into work, half dead.

Like me.

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Dr. Weanus Opines on Nursing Priorities in the Emergency Department

The Resus Room. Trashed beyond belief and almost beyond repair, a stabbing in 1 shipped downtown, a shocky STEMI in 2 just out for rescue catheterization, a tubed CHFer in 3 being packed up to go to ICU,and a fresh cerebral bleed in 4. All in three hours. Blood-soaked abd pads, empty IV bags and other garbage litter the floor, the trauma cart stands gaping open, the code carts need to be restocked, the wall suction exemplifies charnel house grottiness, and the nurses have retreated to that warm fuzzy place from having too much, all at once, but knowing lives were saved.

And way back in 5 is the half-forgotten 79 year-old female NSTEMI leftover from Nights, whose troponin is barely distinguishable from that of a 16 year-old girl,  and who is utterly stable, and complaining about the food, the bed, her family, and the ambient temperature to anyone who will listen.

But not forgotten by our Dr. Weanus, whose advocacy for the patient is fierce and unremitting.

He roars into the Resus Room.

This is unacceptable, he shouts. Patient safety has been compromised! I shall have to report you all! You are all incompetent and have no place in a critical care area! You are all lazy! Look at you sitting there!

The nurses look slowly from the blood soaked stretcher in 1, past the opened TNK packages, the art line  and central line kits, the rasping vent, the flasks of infused Voluven, the scattered vials of Versed and propafol, the sputum dripping off the walls like it had a life of its own, the backboard carelessly propped up against the wall, the family huddling around Bed 4, and back to Dr. Weanus.

What exactly is the problem, Dr. Weanus?

He assumes the posture of disgust and outrage. Clearly standards are slipping. “It’s a clear dereliction of nursing duty.”

What?

“You have not written down the dosages of this patient’s medications!”

My favourite internist.

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Except for the Fever, Malaise, Rigours, and Myalgias, I Feel Great [Updated]

My new favourite acronym is ILI, which stands for Influenza-Like Illness, which everyone in the Greater Toronto Area seems to have contracted in the six days I’ve been off. Après le weekend, le déluge. Or so it would seem. There has been a wee panic here, egged on by the media, over the unfortunate death from H1N1 of an apparently previously well, athletic 13 year-old boy. Acme’s emerg saw 129 patients yesterday during day shift, and I swear every second patient had “Cough and Fever” or some variation as their presenting complaint, most of them brought in by mothers (and fathers) who were convinced that little Braden or Jasmine had the pig flu, and that we needed to Do Something.

Unfortunately Doing Something means approximately Doing Nothing, except the usual push-fluids-and-Tylenol-and-return-prn routine. We aren’t even swabbing — but that’s assuming little Braden or Jasmine even had symptoms more specific than a vague cough.

Flu vaccination clinics for the general population start in Toronto tomorrow. Acme Regional Health is not starting its employee vaccinations until next week. Occupational Health has given no explanation of this particular piece of stupidity — it probably has to do with the original timetable for the vaccine rollout, and Acme’s inflexible and nonresponsive management style as anything else — but health care workers were supposed to get the vaccine before the general population. Occ Health has helpfully suggested that we go to the public clinics.

Meanwhile your humble faithful correspondent has, yes, developed Influenza-Like symptoms which escalated rapidly yesterday at work from a ephemeral feeling of malaise to fever and myalgias by the end of shift. Ugly. I came home, took a gram of Tylenol, and slept twelve hours straight. And I still feel feel like crap this morning. You think this counts as my flu shot?

[UPDATE @ 1850] The wee panic has turned into a tsunami. A call to a colleague revealed Acme’s ED saw 112 patients overnight. Sick Kids saw double the normal in its Emerg, and Mt. Sinai across University Avenue has confirmed an outbreak of H1N1.

Meanwhile in now there are five of us from our emerg out with Influenza-like illness. And feeling worse this evening after a brief daytime rally — had some bad rigours this afternoon.

I’m starting to feel a little apocalyptic. Which is the flu talking. I think.

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Fundraising Tip: Try to Look Like the Community You Serve

Acme Regional Health has a problem. Its fundraising efforts suck. If you can call charity auctions and golf tournaments fundraising: they’re more like church bake sales, only larger.

I was thinking about this when I was perusing Acme’s website and came across the list of Board members. Out of fourteen members of the Board, two are people of colour. Out of twenty-one members of the Board for the Acme Regional Foundation (which does the actual fundraising), three are people of colour or from a recent immigrant community.

Very odd, I thought. I am not saying there’s racism going on. But maybe some stupidity: over half of the people living in the City of Toronto proper are foreign-born, and a very large percentage of them are people of colour, and Acme Regional itself is located in a part of the GTA which has a very large and diverse immigrant community.

So why does the board of either the hospital or its foundation (or the professional fundraising staff) look nothing like the community it serves? And maybe the tokenism has something to do with its dismal fundraising efforts?

Maybe firing the current fundraising staff  (who all look like my high school yearbook — I grew up in very small town Ontario) and hiring some bright young energetic speakers of Tamil, or Punjabi, or Urdu or Farsi or Arabic to network  and generate community support would be useful. Better than pretending it’s 1965, when being multicultural  in Toronto meant you invited a Catholic to your Tupperware party.

Just a thought.

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What’s Wrong With This Picture?

Two contradictory headlines. Or further evidence no one really wants to live in Winnipeg.

Nurses worry about job losses with cuts (Victoria Times-Colonist)

Nurses in Victoria will lose jobs when the Vancouver Island Health Authority implements its recently announced cost-cutting measures, the B.C. Nurses Union said yesterday.

Ronni McCallum, South Island co-chair for the union, estimated that in Victoria alone, more than 30 nurses will lose their jobs, and about 20 more would be affected.

Not enough nurses (Winnipeg Sun)

Myrna Driedger, the Tory health critic, publicly released figures yesterday she obtained from the Winnipeg Regional Health Authority, which show 81 of Winnipeg’s 418 emergency room nursing positions were vacant as of June 15.

“They cannot provide safe, quality care when you’ve got a shortage of 81 nurses in our ERs,” Driedger said. “The ER nursing shortage is the worst it’s been in four years.”

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If Poe Had Sat at Triage

This is insanely funny and well done.

I only wish I were half as clever.

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Ending an Abusive Relationship, or, Why I Hate Bell Canada

I had a very tiny question to ask Bell Canada last week — I mean really trivial. My phone number had changed because of some harassing calls and I was unclear whether this would affect how I paid my Bell bill over the Internet. Easy question. One that you would think is actually fairly common.

So I called Customer Service, which in the land of Bell Canada, means a journey down some dark and twisty roads.

First off: put on hold, which is never promising. And then after speaking with five agents, being dropped not once but twice, and wasting 65 minutes of my life, not to mention the emotional trauma of becoming volcanically angry, I got an answer to my friggin’ question.

A bit of context. In the decades I have dealt with Bell Canada, I have called Customer Service maybe five times. And every time it has been the same story of ignorance, evasion and nonanswers. I cannot remember a pleasant, easy conservation with any Bell Canada service agent. I’m positive Bell Canada pisses off hundreds of customers daily. For how many is speaking to Customer Service agents the end of the line, so to speak ?

For me it was.

Bell Canada, I have put up with your condescension, your arrogance and your crap for 27 years. I kept thinking it would get better, but it hasn’t. And then I finally figured it out. We do not have a relationship of mutual respect. Our relationship consists of you abusing me, and me taking it and coming back asking for more. It is the classic relationship of the abuser and abused.

And guess what, Bell Canada? You aren’t a monopoly anymore. I don’t have to take it. I quit. I quit you and all your works. I know you don’t care if I go over to the competition. There are plenty more sheep. But I hope other people do in thousands and hundreds of thousands until you get the message: your customers need to be treated with respect. Because we won’t keep coming back.

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