Posts Tagged Silliness

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English: Linear Skull Fracture with arrow poin...

What this patient did not have

Mr. CD, 88, took a little tumble at the nursing home when he slipped on a loose rug (or something, the details are a little vague here), obtained for his trouble a scalp laceration the length of Q-tip on his temple, bled like a stuck pig, transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, declared medically cleared and fit to go home, deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

Whereupon the RPN (i.e. LPN for you out of province types) or whoever was minding the door of the nursing home refused to take the patient back.

“Oh my God, he needs to go back the emerg,” she said, eyeing, perhaps, the overwrought head bandage. “He has a skull fracture! I can tell!” And promptly sent him back, alert, oriented x 3 — and bemused.

I have only two possible explanations for her extraordinary statement: she either is wasting her time at the nursing home and depriving humanity of a set of assessment skill so exquisite she can, using her psychic x-ray powers, detect a skull fracture under approximately twenty layers of clean, white 4 x 4 sponges and tape gauze, or else she thinks despite all the assessments and investigations, we are complete boobs. ( Admittedly, I have a sneaking sympathy at times for the second possibility.)

There is actually a third possibility, but I am far too polite to mention it.

That’s all I got. Feel free to insert your own snark.

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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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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.

__________

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

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How to Clear Out a Waiting Room

A couple of weeks ago we had a spectacularly bad day, traumas, codes, STEMIs, septic shock, status asthmaticus, what have you, plus (of course) a department filled with the haunted faces of the damned admitted patients and volumes of epic proportions. Faced with an angry and hostile waiting room overflowing with the walking wounded, the triage nurse made an announcement.

“Can I have your attention, please!” she shouted. “Because of four critically ill patients in the department, THERE WILL BE EXTENSIVE DELAYS TO SEE A PHYSICIAN. Thank you for your understanding.”

Ten patients immediately got up and left.

I know patients come to an emergency department for reasons the health care  professionals treating them might question, and that what we consider to be an emergency often diverges wildly from how a patient might perceive it. Nevertheless — I’m thinking, maybe, for those patients it wasn’t that much of an emergency, and just maybe, their GP or (God forbid) a walk-in clinic might have been a better option and better use of health care resources.

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Saving the World from Terrorist Breastfeeding Toddlers [UPDATED]

An Atlanta, Georgia suburb is fighting one of the most pressing causes of our era — children who breastfeed past twenty-four months. Because breastfeeding after the age of two will damage human society beyond repair:

On Monday night, Forest Park passed a public indecency ordinance to prevent public nudity. Previously, the city only had a public indecency ordinance that covered adult entertainment businesses.

 According to the law, no woman can breast feed anyone older than 2 years old in public. City manager John Parker called the law a proactive step.

 “It sets up a process whereby we can try to control nudity throughout the entire city,” Parker said.

There was, in response, a public nurse-in ridiculing of the notion of breastfeeding posing a clear and present danger to societal values, and a response to the nurse-in predictably filled with comments from various yobs and jackasses. What I’m not getting, though, is the conflation of breastfeeding (regardless of the age of the child) and public indecency. Or stigmatizing  a practice which is healthy and beneficial for both child and mother, and for 99.9999% of human history was the normal means of providing nutrition for infants and young children and continues to be for the vast majority of the world. Oh, but there’s this bit of enlightenment:

Do you think he — or the Forest Park City Council — knows what projection means?

UPDATE: I was gulled (blush), as Jenn points in the comments, by a hoax. “Citizens Against Breastfeeding,” portrayed in the Youtube clip, as snopes.com points out, is a prank. Such are the times when even an outrageously obvious hoax is believable — and yes, the point still stands.

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Observations and Assessments

Notions too small for a blog post all in one place.

April Foolishness. I guess I got  — or more likely annoyed — a few of you with my little April Fool’s prank. In case you missed it, I faked a news report from Trout Creek, Montana (pop. 261) stating the local hospital was going to fire all it nurses and replace them with housekeepers. I even put up a picture of some hospital in India, complete with palm trees (in Montana!). Some of you waxed quite indignant before realizing it was the First of April. What’s interesting is how readily people believed it — which speaks volumes about nurses’ perceptions about how they are valued by their employers. Which is to say, not much.

Nurse goes all postal on Craigslist. This epic rant has been making the rounds — those with delicate sensibilities may want to avert their eyes:

Well, after a year of getting rejected I have finally decided to give nursing the bird. FUCK YOU NURSING FIELD! Too bad the schools and media are still insisting that people go to RN school. Believe me THERE IS NO FUCKING SHORTAGE! New grads are considered garbage. On top of that, the degree serves no purpose in any other setting. BSN is a complete waste of time and money.

I know, “some people got jobs”. That does not justify the majority (1000’s) who did not and are now working retail for minimum wage. There is something fundamentally wrong with this country. My school counselors, nursing instructors, media and nurses I know urged me to go into nursing. As soon as I got my degree and the check to the school cleared I heard the unmistakable sound of the door to nursing closing—slamming actually. And it is not just the economy. Hospitals turning huge profits stopped new grad programs and hire foreigners.

It is over. I am a stale grad and I am out of options. The new graduates fresh out of their precepts will be flooding the market to add to the already rancid oversaturated pool of disgruntled STALE GRADS. So, I guess giving up a nice job for school, dedicating 6 years (yes, I was foolish enough to get the BSN), dropping 20 grand and putting up with nursing school stress was all for nothing.

And no, higher education is out for 2 reasons. One, you need RN experience to qualify for any NP program. Second, why would I throw more money at a system that just failed me and ruined my life? It is clear that the educational system is bunk. I am completely embarrassed at the education I experienced at the California State University–It is appauling.

I hate nursing. I hate it so fucking much now. The true colors of the profession are now clear. So, now society can have a derelict because that is what I intend to become. I now plan to make a living mooching off the system.

It would probably take a year of posting to unpack all of this. Suffice to say, I do have the tiniest bit of sympathy for her, as I graduated at the nadir of nursing joblessness in the ’90s and was forced to work part-time for the first three years of my career. That being said, I wonder at her commitment to the profession, despite the six years of expensive education; one senses she wants her dream job handed to her on a platter. It doesn’t work like that. So I’m with everyone else: don’t let the door hit you on the way out. Or else come to Toronto — I know some 5 North nurses who would love to have you as a colleague — and they’re hiring.

Uterus, uterus, uterus. In another take to the uterus-as-filthy-word story, now you can incorporate your womb. (Thanks Terri!)

Take me to your leader. In case my American friends and readers haven’t noticed, we’re finishing up the second week of a federal election campaign, where the forces of light and the agents of doom and darkness will collide in a colossal battle for the heart and soul of the nation, etc. Being the flaming left-wing commie-pinko-socialist I am, I will prevaricate until the very last minute till inevitably holding my nose and voting Liberal. All which is to say, if I seem more, um, political in the next few weeks, I can’t help it, it’s the environment.

Hope they were praying for epinephrine. Speaking of Members of Parliament, there’s a report in the Le Devoir this morning that three Conservative MPs witnessing a severe allergic reaction on a flight to Taiwan responded by laying on the hands and praying. I guess I slept through that part in my critical care courses where Prayer comes before Airway, Breathing, Circulation. [ Via. ]

Non-nursing blog shout-out:  Worcester College Gardeners — actual professional gardeners charged with the maintenance of 26 acres of grounds surrounding Worcester College , Oxford, U.K. Reading through the blog puts lie to the notion of effortless gardening: it becomes quickly very apparent all those charming, perfect English garden scenes Canadians wax green over are the result of some pretty intensive labour. What I could do with a flock of minions and unlimited cash!

A pair of quacks. I was happy to learn that both Mehmet Oz and Andrew Wakefield, the fraud-mongering anti-vaccination advocate, were recipients of the annual Pigasus Awards. Oz — and any self-respecting  nurse is always glad to see him taken down a notch or two — was given the award for promoting such quackery as energy fields and faith healing and advocating the bereaved call a psychic for consolation. (Why is this jackass still on television?) Wakefield got the award for continuing to peddle his nonsense despite being called out by the Lancet and the British Medical Association.

Mini-rant. To anyone who has cut and paste from this blog: it has come to my attention bits of my writing — which I remind you are not free, in the sense you can use them at will — are being circulated unattributed and altered contrary to the copyright notice on the bottom of this page. Please note that even if you did not see the copyright notice, you are still subject to its provisions. In other words it is your responsibility to ascertain your obligations.

I really don’t mind people lifting my writing so long as it’s unchanged and attributed to me. I actually like it, because it’s free publicity. But when I find my original work altered to the point where my authorship is in doubt, it starts to piss me off. When you don’t link back to me, you become a thief.

P.S. When I write “shit” I mean “shit”, not some milquetoast euphemism you have determined won’t offend your readers — which  incidentally doesn’t nullify the copyright either.

P.P.S. Why do I think it’s a losing battle?

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Uterus and Other Bad Words

More April Foolishess, but real this time, from the Florida legislature. Here a blow was struck for the advancement of science by making “uterus” is a dirty word. I suppose that there is a certain delicious irony about objecting to the use of the word “uterus” during a debate on abortion, though I doubt those who find the word offensive would get it:

At one point [State representative] Randolph suggested that his wife “incorporate her uterus” to stop Republicans from pushing measures that would restrict abortions. Republicans, after all, wouldn’t want to further regulate a Florida business.

Apparently the GOP leadership of the House didn’t like the one-liner.

They told Democrats that Randolph is not to discuss body parts on the House floor.

“The point was that Republicans are always talking about deregulation and big government,” Randolph said Thursday. “And I always say their philosophy is small government for the big guy and big government for the little guy. And so, if my wife’s uterus was incorporated or my friend’s bedroom was incorporated, maybe they (Republicans) would be talking about deregulating.

“It’s not like I used slang,” said Randolph, who actually got the line from his wife. He said Republicans voiced concern about young pages hearing the word uterus.

In the interests of prurience, and also of saving tender ears, from, well, science and education in general, I have composed a list of objectionable medical words:

Penis: Well, duh. Also better exclude the adjective “penile”. Also “penal” is problematic. Use “prison.”

Testicle: Again, duh. Testimony, testify etc. are dubious too, doubly so, given the fact (male) witnesses in ancient Rome held their spuds while in court.

Clitoris: Triple duh. Flogging offence. Do not EVER use. As a substitute, I’ve always liked le bonhomme au canot, which has a certain charm, but might be objectionable in the U.S. because it’s so obviously French. Best never to speak of it, or even think about it.

Cervix: Leads to the u-place.

Vagina: Leads to the, um, cervix. Also, do not use “Regina” as in the capital of Saskatchewan, because you might think of what rhymes with Regina, and that is the road to Hell.

Coccyx: Do you really want to say this in public?

Bartholins’s Gland: Just sounds dirty.

Mesentery: Say it with me, slowly: ME-sen-ter-ry. Get a little illicit thrill? Don’t use it.

Menstruation: Eeew.

Masturbation: Is a sin, and therefore the word is sinful. Only use if you’re sure you worship the Devil:

Abdomen: Where the u-place is, and is close to other “bad” parts. Avoid. Use “tummy” instead.

Pubic: Generally offensive, and in any case it’s not a word you’re likely to drop into everyday conversation:  “Hey, I have a pubic lump.” Not.

Anus, rectum, colon etc.: Someone, somewhere will be offended if you use these.  Besides, they are icky.  Just don’t.

Buttock: Near the above. Makes you think of other, more collequial, badder words.

Oral: Do I really need to tell you?

Epididymis: Only leads to troubling questions of the knee-bone-is-connected-to-the-thigh-bone type. In any case most guys don’t realize they possess them.

Semen: Only should be used when speaking of sailors.

The list, actually, could be endless. Feel free to add.

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“The Latest in Sanitary Conveniences”

[A rerun: I will return on 16/02/11. I feared when I reread this, thatI might have been a little harsh. After due consideration, no. However, the new low point in Western civilization was actually the email I got some little while later telling me “even the obese have the right to a clean perineum.” Amen. Originally posted 1/10/09]

The telling lines: “it extends your reach by a full eighteen inches” and “follows the contours of your body and comfortably cleans.”

Dear Lord.

I know, before you tell me, about the folks with back injuries and decreased range of motion and the morbidly obese who can’t reach around.  (That there is a market for this product may represent the nadir of Western civilization.)

But still.

Dear Lord.

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“Dr. Weanus Opines on Nursing Priorities in the Emergency Department”

[A rerun. Dr. Weanus strikes again. With slight modifications, from 29/10/09]

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 done too much, all at once, but knowing lives were saved.

And way back in 5 is the half-forgotten 79 year-old female NSTEMI left over from Nights, whose troponin is barely distinguishable from that of a 16 year-old girl: 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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Revenge is Best Served with Cat Pee

Found on Staff Lounge Bulletin Board

Dear Colleague

When I went to lunch the other day, wanting to hot up an otherwise tepid General Tao’s chicken, I noticed my bottle of hot sauce, the one that was made by a Mayan women’s collective using organically grown heirloom chili peppers and which I bought at a hoity-toity food shop in Yorkville for a ridiculously inflated price, was missing.

Clearly, this is my fault.  When I labelled the bottle, “Please Feel Free to Use” in a fit of unwarranted generosity, you interpreted my label to mean, “Please Feel Free to Use at Home.”   Clearly I was not plain enough in my meaning.  I should have written,”Please feel free to use in the staff room ONLY.”  For this apparent confusion, I apologize.

In order to prevent further misunderstanding in the future, you will notice I have placed two bottles of Frank’s Red Hot Original in the staff lounge refrigerator.  Into one of them, known only to me, I have instilled a small amount — not more than, say, 1 cc — of the most obnoxious substance known to humanity.  I speak, of course, of CAT URINE.  Or maybe I haven’t.  You will never know.  The point being, are you willing to take the risk of ingesting CAT URINE?  And what about your children?

Little more, I think, needs to be said on this matter.

Thank you for your understanding.

Yours truly,

[REDACTED]

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