Archive for August, 2011

O Why O Why Did I Pick Up The Phone?

Phone rings.

I look around.

There is no ward clerk in sight.

Damn.

I answer. “Emergency, Charge Nurse.”

“Can I ask you a question?” The voice on the other end sounds flat and tired.

“Sure,” I say warily.

“I came to see you guys a three days ago and I had a sore chest and you guys did a whole bunch of tests even though I told you my Ventolin had run out and my asthmas was real bad, and you did nothing for it, and the nurse was real rude, like, and you guys took blood and, and did a heart test I did an xray, and I was real afraid of the xray ’cause of the radiation, and I don’t want to get cancer or nothing ’cause i already got cancer like my mother who died of breast cancer and the doctors didn’t do nothing, and then the doctor told me I had an infection in my chest and I think it he said it was pneumonia and he gave me a prescription and I got it filled and I took the first dose tonight, and it didn’t do nothing, and now I have a rash on my arms and stomach and it itches real bad —” The caller paused for breath.

I jump in, wondering where exactly the question lay. “Are you asking for medical advice?”

“I guess. Can you help me?”

“We don’t give out medical advice,” I say. “You can call Telehealth, and they should be able to. You have pen and paper and I’ll give you the number?” I think, please let me give you this number, so I can end the call. She’s not having any of it.

“Are you guys busy?”  she asks. Every emergency nurse knows this question, and we all have the same answer.

“I can’t answer that,” I say. ‘It depends on how sick the patients are, and how many people come into the emerg.”

“How long is the wait?” she persists. “Will I have to wait long?”

“I can’t answer that, ” I repeat.

“Can I pre-book an appointment?”

“I’m sorry, no.”

“Well, thank you for fuck all!” She bangs the phone down.

Thanks and you’re welcome, I mouth. Another happy customer who has made me very glad to be a nurse. And ten minutes of my life gone for ever. I swear I will never pick up the phone again. Really. I mean it.

The phone rings.

I look around.

There is no ward clerk in sight.

Damn.

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Buskerfest

Where I was Thursday. I’m not very good at writing art review-style critiques using high-flown language, but I can say that I enjoyed Buskerfest a lot. There’s a bit of an edge to the performers. They generally live on the margins. They swear freely, even with children present. (O the horrors!) They’re tattooed and pierced, they are sometimes scruffy, and few are, to be a honest, a little creepy. The festival is not in anyway sanitized, which is why I think it is so successful. Some highlights:

Kate Mior. (Website.) One of the best we saw.

(Kate has already run afoul of His Worship the Mayor. According to Now:

Kate Mior has performed her mime-based living statue act for thousands of people all over the world, but she’ll never forget her encounter with Rob Ford.

Last year in Toronto, then-candidate Ford pushed through a crowd she was entertaining and then joked to everyone that she doesn’t pay her taxes.

“There is a certain stigma against street performers,” she acknowledges, “but in Toronto that’s changing.”)

Comment seems superfluous. More Kate:

Acrobats.

More acrobats.

This guy was quite good too. He had put some sort of shield or mask over his eyes to make them look mechanical. The effect was quite disconcerting.

But my favourite? HERE COME THE BUGS!!!

The bugs were great. We loved the bugs.

And no collection of bugs is complete without a Bug  master, who deserves special mention of his own

It’s a great festival, and if you’re downtown this weekend, check it out.

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What I Found in my Garden

A turtle.

I remember as a child reading about turtles (or tortoises) in England, where all proper gardens seemed to have one — and being rather charmed by the idea. So I’m pretty pleased this gentleman (or lady) is residing in mine, even if temporarily. Every garden needs a turtle, in my opinion. (Under this crusty exterior, you see, lurks a sentimental fool.)

I have no idea of the species, but I’m guessing it’s a painted turtle. You can get an idea of the size by the paving bricks.

Also, a purely gratuitous cat picture, since I haven’t posted one of the wee moggie in a while. She looks so, well, innocent, doesn’t she?

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Snapshots of Nursing History

Courtesy of the National Archives of Canada.

Two nursing students from the John H. Stratford Hospital Training School for Nurses (later re-named the Brantford General Hospital School for Nurses). 1895

Nursing Students, bed making. Medicine Hat Regional Hospital. You get the notion the attentiveness is feigned. Making mitred corners is not that interesting.

Nurses at St. Michael's Hospital, Toronto. Three nurses, two nuns, a sterile tray. Note the (presumably sterile? clean?) wimples.

Nursing students being instructed in dietary science at the Hospital for Sick Children, Toronto.

Nursing students in a lecture theatre, Hospital for Sick Children. Note the instructor is in full nursing uniform: role modelling both behaviour and appearance --- deportment --- was considered a vital part of nursing education.

When psych nurses wore crisp white uniforms.

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About Jack

Hearing about Jack Layton’s death from cancer driving home yesterday was like a hard punch in the head, and I nearly went off the road. My American readers may not appreciate the genuine respect and affection most Canadians had for the new Leader of the Opposition, even if they vehemently disagreed with his politics. I don’t think I have anything to add to the many, many tributes and obituaries, except this: though I was severely critical of Layton’s stance on the gun registry, he convinced me to vote for the New Democrats this spring for the first time in a federal election since ’93.

Here’s Layton at St. Joseph’s Hospital, Hamilton for the television program Make the Politician Work.

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Choking on Your Own Vomit

Aspirating while more-or-less obtunded because of alcohol poisoning is not pretty, and I’ve seen a few VSAs related to chocking on your own puke that had very poor outcomes. Hence my interest in this PSA from the British Red Cross. (Facebook here.)

[Via.]

I’m actually a little skeptical an adolescent/young adult on some colossal piss-up is going to help their BFF into the recovery position  to protect their airway, even if the ad is presented in a way that doesn’t presume to hector or nag, if only because selfless atruism is not the defining characteristic of the age group — or any age group, for that matter, as I noted yesterday. Or maybe I’m just being the old and jaded ED RN.

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In Which TorontoEmerg Discourses on Some Aspects of Human Nature

It’s probably more than little trite to say the Emergency Department is a microcosm or laboratory of humanity, but like most clichés it has an element of truth. We see all types in the ED, the good, the ugly, and the purely despicable. (And then I could talk about the patients.) We’re human, after all. But in general, ED staff are as generous and warm-hearted as anybody anywhere. For example, when one of us is injured, or has a death in the family, or is seriously ill, we’ll take up a collection, and sometimes we raise surprisingly large amounts of money. Enough is donated, usually, to cover incidental expenses, and to keep our colleagues in need well-supplied with parking passes and Timbits while getting cancer treatment (for example) at Princess Margaret.

Well and good. Very nice. Pat on the back and warm fuzzies and Hero Medals for everyone.

A recent counter example: a colleague diagnosed a little while ago with a very serious and probably terminal illness. Fine, I said when I learned this coming into work. Where’s the envelope?

Blank stare.

What envelope? came the reply.

“You know, I said, “the collection envelope.”

“Oh, there isn’t one.” An embarrassed laugh. “You know, Jane is really irritating and no one really likes her.”

I got it. In my ED, evidently, supporting and helping a colleague is a popularity contest. If you’re well-liked and “one of the girls,” it’s roses and wine and parades. If not, you get the proverbial lump of coal in the stocking. Jane, it seems (a little sadly) had anticipated all of this voiceless nastiness, and was refusing visitors from all but her closest friends. Yes, we aren’t that far away from high school after all, and nourishing a sense of compassion evidently doesn’t rate very high on self-improvement.

My nurse colleagues are smart and engaged and have empathy by the yard. I love them all for their exquisite skills in nursing, but sometimes I really don’t like them much at all. This would be one of those times.

Also: this only goes to prove the point that nurses aren’t angels. They can be jerks and asshats like anyone else.

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Observations and Assessments

Notions to small for a blog post, all in one place.

You need to take your pain medication. Once upon a time, TorontoEmerg had some fairly significant surgery on a major joint. It was (theoretically) exceeding painful, but fortunately TorontoEmerg’s orthopod was very generous in supplying TorontoEmerg with Percocets and Tylenol 3s, and thusly TorontoEmerge experienced very little pain. Even when going to (really) painful physio, TorontoEmerg was kept more-or-less comfortable and at the end had a full recovery —- all because of adequate pain control.

TorontoEmerg was an RN, and knew how to take pain medication effectively.

So when five patients show up at Triage in one with poor pain control post operatively, even with adequate analgesia prescribed, TorontoEmerg begins to think some surgical nurses know squat about pain control and/or failing to teach adequately about analgesia when discharging patients. It isn’t about throwing a script for some opioid at patients and telling them to take the med “when the pain is really bad.” Is there is some deficit in our training which makes us reluctant to counsel patients on pain control?

You need to take your stool softener. Same topic. Different angle. I had several patients come to Triage yesterday for constipation related to opiate use post-operatively. None of them had any instructions about preventing or addressing what to do about the (inevitable) constipation. Again, why are we screwing up our discharge instructions?

Myth of the Queen Bee. Some research probably pertinent to nurses aspiring to leadership positions.

Drop Me a Postcard. This is kind of cool: internet postcards you can drag and drop to email, Facebook/Twitter messages, which pose some pertinent, challenging, difficult questions. From droppingknowledge.org.

How to deal with difficult colleagues. It seems too simple.

“Please do not let them breed.” Yep.

Size does matter. I thought this story was interesting because it exemplifies the anti-science, anti-intellectual climate we seem to be labouring under. Shorter version: right-wing web sites excoriate supposedly taxpayer-funded study of penis size and gay men’s health as trivial and frivolous, except, as it turns out, the study was not directly funded by the U.S. government and there is in fact an important correlation between sexual health and penis size, which in turn has implications for reducing HIV transmission.

Speaking of bad foodDeep fried butter. Really. Move over cheeseburger-on-a-glazed-doughnut. As Sean says, I’m speechless.

Dumb road signs

 

 

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A Matter of Hours

I was talking the other day to young, surprisingly old-school physician who bemoaned nurses “doing things” she thought properly done by duly authorized medical practitioners. (She also implied, by-the-by, that when physicians said “Go fetch,” the proper nursely response was a demure “Yes, doctor, and do you want your neck rubbed?)” Clearly, this physician thought, medicine was the senior and superior discipline, and nurses should defer at all times to their judgement, even on matters clearly within the sphere of nursing. Her basis for this line of thought was that physicians got “thousands and thousands of hours” of clinical and classroom education while nurses only had a “few hundred hours of  dubious training.”

My head almost nodded, subconsciously anyway, in agreement. Got us there. It’s a common theme, actually, when you see discussions of nursing versus medicine. Nurses just don’t have the education, it’s claimed, to make the really important decisions in patient care. But then I thought about it for a bit.

Leaving apart the obvious — that medicine and nursing are two different (if related) disciplines — in point of fact, I had 1950 clinical hours and about 2000 hours of classroom study to become a Registered Nurse — and this doesn’t include the hundreds of hours more of post-graduate education to gain speciality certification and also training for things like ACLS and TNCC. I know it doesn’t compare to the extensive/intensive training of physicians. But still, nearly four thousand hours of formal training as a minimal entry to practice is nothing to sneeze at either, and hardly the “few hundred hours of dubious training” imagined by some physicians. At any rate, it makes me wonder why, given our own expertise, education and experience, why some nurses continue to be cowed by claims of physician superiority?

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You Want a Side of Plavix with That?

Doughnut burger: a bacon cheeseburger served i...

Now that's good eatin'. Image via Wikipedia

Now arriving at the Canadian National Exhibition — wait for it — the doughnut cheeseburger*:

The Doughnut Burger made its debut at the Calgary Stampede, where brave revellers downed the sweet and salty snack, despite its high calorie count.

Now the hefty bacon cheeseburger with two maple-glazed doughnuts for buns will be featured at the CNE in Toronto.

The heart-stopping treat packs a walloping 1,500 calories and is sure to draw at least a few curious consumers.

The maple glazed doughnuts are a nice Canadian touch, eh?

Just for comparison, Micky D’s Big Mac (my guilty little secret) packs 704 calories, and a Harvey’s cheeseburger (Harvey’s is a Canadian burger chain) is a “mere” 460.

Can anyone explain the appeal of these? Is anyone actually tempted? I mean, if I’m going to consume empty calories, I think I would save them for something good.

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*Rather like the Lady’s Brunch Burger, sans egg.

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