The last laugh

I love when I get the chance to have the last laugh... and I owe it all to an aware Pharmacist at Local Pharmacy.

My night shift started off with a patient and her husband who were very upset, to say the least, that the patient was not discharged from the hospital. The discharge was being held up waiting for a doctor to come up and assess the patient to make sure she was safe and ready to be discharged. I mean... the patient was post brain surgery. But that was not of the concern of the patient or the patient's husband.

Long story short... the patient was yelling (although she claimed that we gave her the worst headache of her life), the husband was yelling. In fact the husband was literally in my face screaming, spitting, and turning red. Security was called. It was great... it's what I get up in the morning for (read with sneering sarcasm).

The patient is demanding her IV Dilaudid because her oral Percocet was not working. But she wanted to go home immediately. I'm still not sure where she thought she was going to get IV Dilaudid at home from... but I can make a good guess.

Finally we get the patient discharged, scripts in hand. Goodbye and good riddance.

About 3 hours later we get a call from the Local Pharmacy who wants to verify some scripts that we had discharged a patient with earlier in the day. Surprise... it was the very same patient who made my life so fun just a few hours earlier. The pharmacist was concerned that the narcotic prescription had been altered.

First... you treat the very nurses, who cared for your sorry ass after you just had your BRAIN cut into, like pond scum. Second... your husband comes close to what could be considered assault on a human being, aside from the fact that assault on a health care worker is a felony. Third... you threaten a law suit to anyone who dared look in your direction. And lastly... you ALTER your narcotic prescription??? And then you try to pass it off?? And now you want ME to verify the script... ME? (Do you remember what you said to me? Do you remember what you called me? Do you remember that your husband covered me in his saliva? You are lucky that I'd rather make sure your got your meds than risk you coming back to the hospital!)

Prescription did indeed appear altered.

So now you have NO pain medication. You likely got the cops called on you if you treated the pharmacist the same way you treated me. AND... I got the last laugh!

Uhhh... ya think??

So over the weekend I saw a patient that was admitted to the hospital because she had stabbed herself in her side with a pocket knife. The pocket knife was probably no longer than 2 to 3 inches, but regardless... it is a knife and it doesn't belong in any part of your body.

I decided to get a little more background on the patient, so I read the EMS report... which is ALWAYS a fun sport. The patient, herself, called 911 for help. Not a bad idea if you just stuck a knife in your side... but I want to know WHY she did such a thing. When the EMTs arrived on the scene they found the patient in the shower, wet, naked, and holding a towel over her stab wound to control the bleeding. WTF?? She called 911 and then got in the shower? She told the EMS crew that she wanted to make sure she was clean when they got there. Hmmm... I'm starting to see a pattern of bright ideas forming. So then the EMS crew loads her up into the ambulance to bring her straight to where I work... damn it.

So along the way to the hospital, which I'm sure included passing by other hospitals (lucky bastards), they ask the patient some background information and the question of all times... WHY? The patients pertinent background information includes that she has been doing meth for 2 days. Ahhh... clue number 1. It also included that she had drank 2 cases of beer and a fifth of vodka. Clue number 2... but I STILL don't understand why. So the EMS crew finally ask her if she was trying to commit suicide. The patient said "No, I would say it was just poor judgment."

UHHH... YA THINK? DO YOU REALLY THINK?? STABBING YOURSELF IN THE SIDE IS JUST POOR JUDGMENT??

A little lotion...

This is an old story from my days of nursing school... and one of my more embarrassing.

I was doing my rotation through couplet care... mom and baby area. Nothing I have ANY interest in whatsoever. I'm happy for them... it's great... blah, blah, blah. I like the blood and guts.

Of course, by this point in time I had no introduction to 'incontinence cream.' Also known as barrier cream, baza cream, ect. It's basically a very thick waterproof cream that we use to create a barrier between a patients skin and the bed that they will eventually wet. Wet bedding against skin is a recipe for disaster. So while we check and change beds often, it is still best to protect the patients skin from the moisture all together.

So here I was, this silly little nursing school student in her white pants and university scrub top, wandering around in couplet care looking for an IV to start or something/ anything to make the shift a little more productive for me. (As bottle feeding an infant really didn't interest me!) I washed my hands for the 954,736 time that day and my skin felt like it was about to peel off so I decided to look for some lotion to soothe the sandpaper that my hands were. I found this white tube of cream. Looked like lotion. It said Johnson & Johnson on it... so I squeeze out a large pile of this cream into my hand. I'm excited that I found this thick cream... I'm thinking it will take care of my hands for sure.

So I start rubbing the lotion all over my hands... WTF. My hands are WHITE and WATER-PROOF. I run to the sink and attempt unsuccessfully wash this stuff off before anyone catches me. This is NOT what I had in mind when I was looking for something productive to do! It took forever to get most of the damn cream off... I went home that afternoon with white still under my fingernails (I was trying to literally scratch the stuff off my hands under the scalding hot water), white around my cuticles, and white in the deep grooves of my hands.

I started carrying around a small tube of lotion in my scrubs.

I work in a zoo

I've decided that I work in a zoo.

In the dead of night, when all the day-shift workers are at home in bed dreaming about how all the night-shift workers are sitting around watching their patients sleep, the nursing unit takes on the feel of a zoo.

The little old confused ladies are screeching nonsensical words or calling out a name repetitively. The confused old men are yelling obscenities. The unfortunate patient that we had to restrain to the bed is writhing around in the bed and trying to chew his way out. The patient off his psych meds is jumping up and down on his bed. Some patient is smoking in the bathroom. IV pumps are beeping. Cardiac monitors are alarming. Bed alarms are blaring. Phones are ringing. A family member wants us to order them dinner. The alert patient is yelling because it's so noisy and it sounds like someone is having a party. And somewhere there is a patient taking off his hospital gown, removing his IV, and taking down his surgical dressing. (I've even seen a patient chew off his splint!)

The nurses are running around like they are in the midst of a prison riot.

I just feel like I'm in a zoo. I'm just waiting for the day when I have to tell a patient that they shouldn't be swinging from the ceiling.

No medical history? At all?

Don't tell me you do not have any medical history if you follow that sentence with your list of allergies. People don't find out that they are allergic to Depakote, Haldol, Geodon, and Lithium by just sheer luck.

And when you were born no one handed you a list of Morphine, Tylenol, Toradol, and Fentanyl as your allergies and recommend that you just request Dilaudid or Demerol when you need pain medication either.

Either that or I must have lost my list... damn it.

Must be bored...

I see this often and have yet been able to figure it out.

A patient will come into the hospital with a valid complaint. They do not appear to be looking for drugs (i.e. pain medication), cause lord knows we get that all the time. So we admit this patient with the valid complaint and begin the workup and consultations to specialists. Different studies are ordered and different medications are started. But here is what gets me... the patient refuses to go to the study/ exam (say an MRI). The patient refuses to take the medication. The patient refuses to have their blood drawn. The patient yells at the nurse whenever they enter the room or try to take a blood pressure. The patient complains endlessly about their original complaint.

Why do you come to the hospital at all if you don't want our care???

Guess what... you don't have to go to your study, take your medication, have your blood drawn, or have a nurse come into your room IF YOU STAY AT HOME.

Complain to your damn cat... they will take care of you the way you plan on letting us take care of you.

When do you call it quits...

We got a male patient in his 70's today that came in covered in what looked like scratches... lots of them. Some deeper than others, many had drawn blood at some point. He was COVERED... head to toe in them. Nicks, cuts, scratches, bruises... he even had what appeared to be rug burn to his butt.

The patient is awake and with the program so we wonder what could be going on here, is it abuse or neglect? So we question the patient, who is extremely hard of hearing mind you, and he tells us his story (and the rest of the hospital with his volume level).

Him and his wife got in a fight yesterday and apparently it was an all out brawl. And I mean a serious, rolling on the floor, scratching, kicking, punching, dragging across the floor kind of fight. In your 70's? With all his injuries you'd have to wonder about the stamina in these two pistols.

Well, wife (also in her 70's) looked much the same. And the police were indeed called to the house during the "event." I don't think I want tickets to that event... I'll pass. But I do want that kind of energy when I get to their age. Who wouldn't like to be able to kick someone else's butt and live to tell the story (without a broken hip) at that age??

But seriously... when do you just call it quits.

Go back to work

This story takes place in an occupational health office of a LARGE corporation. My goal when I work in the occupation health offices is to keep employees at work and productive, this way they didn't have to send employees home all the time or have time missed related to appointments outside the office.

In this office I generally took patients/ employee's in for a number of different things, such as spot checking their blood pressure related to them taking BP medications regularly or checking a temperature or blood sugar, ect. This office also provided phlebotomy (blood draws) for patients who brought in a doctors order, and we sent the blood out to the lab for them... although strangely some people wanted to take the blood with them. Yeah... no, we'll send it out thank you. We also did a lot of patient consultations, basically doing patient education on anything they had questions about, from their new medication they started to breast feeding their new baby at home.

We also saw the mundane... "I don't feel good and think I should go home but my boss wants me to see the nurse." So here is the thing, I am NOT a school nurse, but some of these (adult) employees sure made me feel like one. Employee 1 says "I have a sore throat." I say "here are some throat drops, drink lots of water... now get back to work." Employee 2 says "I burned my finger curling my hair." I say "leave it open to air and keep it clean and dry, go back to work." Employee 3 says "I think I have a fever." I check a temperature and say "no you don't... go back to work." Employee 4 says "My stomach hurts." I say "here is some pepto bismol... now please return to work." (I was being nice that day). Employee 5 says "I'm tired and want to go home." I say... "I can't make that decision for you... go back to work and talk to YOUR boss."

Yes... they pay me to do this!!!

So you can imagine my excitement when a young employee enters the office with the sclera of both eyes beet red and complaining "my eyes... what's wrong with my eyes." Long story short, I spend over 30 minutes with this patient doing my assessment and asking questions. I asked LOTS of questions. I even asked if he had been lifting weights or coughing a lot lately, anything that would cause him to strain... I would think this would clue him in to tell me his story. But he let me go on and on for over a half hour. So finally at a loss, I pick up the phone to call the companies physician for a recommendation (something I tried to avoid if I could). While I was on hold the employee says to me, "could this happen if I was up all morning throwing up." Uh... YEAH... hence me asking you all those questions about recent activities and history. So I ask, "why were you throwing up all morning?" Employee responds, "it was my 21st birthday yesterday. I don't feel well. Can I go home?" My response, "go back to work."

Next time I see this, I'll just ask them if they are hungover. Then I'll tell them to go back to work.

Cold Calorics

A little background on the 'Cold Calorics Reflex Test.' It is a simple neurological test that is done on the comatose patient to test brain stem activity. I stress that it is to be done on a comatose patient, and NOT on the awake and alert patient.

The test consists of irrigating the patients ear canal with cold water (sometimes ice water... but I think this to be a bit extreme). In the patient with an intact brain stem (a good thing), the patients eyes will turn toward the ear that you put the water into and then you will see horizontal nystagmus (rapid horizontal shaking) towards the opposite ear.

If the patient is awake and alert, as I'm sure you can see, they would be quite uncomfortable (ummm... you think), and most likely they will become dizzy and nauseous. I would probably even bet heavily on the fact that you will be cleaning vomit off your shoes shortly after you assault an awake patient with this test.

So here is the best part... I had an ear ache one afternoon and thought it would be wise to rinse/ irrigate my ear canal out. What the heck... we do this in the hospital all the time. Of course, in the hospital we bring the water up to body temperature prior to the irrigation. Well THAT lovely little piece of information escaped my memory while I prepared to irrigate my own ear. So the water I used was not 'cold' but it was NOT body temperature.

My brain stem is intact, my eyes moved the way that they were supposed to, I got dizzy... good news I suppose, although I was already pretty sure my brain stem was fine (I'm thinking my IQ is questionable at this point). Bad news? I had to clean vomit off my shoes, but after I laid down to avoid passing out.

Oh special... guess I'll go back to sticking Q-tips in my ears!

Pre-shift meditation

I do not mean to offend anyone with this, it is just a joke. I found it in a Day-by-Day Calender for Nurses... I'm sure I got it as a white elephant gift at a work Christmas Party!

Dear Lord,

I pray for the wisdom to understand my challenging patients;

Love to forgive them, and the patience for their moods.

Because, Lord, if I were to ask for strength, I would beat them to death.

I don't really know where to begin.

READ THIS... and don't forget to read the comments, all of them!!!

I have heard, seen, witnessed some really stupid people doing or saying some really stupid things. This for sure takes the prize. There are so many many many things wrong with this that I'm not even going to begin listing them. I started reading the post and the comments and was highly entertained. I ended reading the comments just really ticked off and wishing that I could find this Patty chick in the trailer park she must have crawled out of and give her a (very large) piece of my mind. This woman basically slithered out of the trailer park just long enough to go to Walgreen's and attempt to get her fix. After not only exposing her lack of self control to the local law enforcement, she places a post on Ripoff Report.com to broadcast her stupidity and clear lack of education for all the world to see. And to top it off she comments back often with more ignorant statements.

So this very kind of thing is exactly what this blog is all about... WHEN I THOUGHT I HAD HEARD IT ALL... Patty, in Apache Junction, Arizona, just upped the ante.

And no...

I spent this beautiful Sunday with a couple of my friends catching some rays (say... sunburn and dermatologist appointment!) and discussing what we like to call our "bucket list." It's not necessarily the list of things that we would like to do before we 'kick the bucket', it's more along the lines of things we would like to accomplish before the end of the season. For example, we had a bucket list for the spring that included spring type of activities. A separate one for summer and so on. You get the point. So we are preparing the 'bucket list' for the last 3 months of the year... and it's funny how fast our time fills up... only accentuating how fast our lives are flying by.

Some how we got on the topic of going on a cruise. Both of them have been on several cruises and I have not been on one. So they are explaining to me what it's like to cruise and about the different activities. And here is the conversation to the best of my memory...

"All you have to decide each day is what side of the boat you want to sit on, if you are going to climb the rock wall... they even have ping pong tables. (slight pause) And no to the macarena."

I laughed so hard... sounds like the cruise has a lot to offer. What with ping pong tables and all. But note taken... should I actually get on a cruise ship one day I will say no to the macarena.

Can I use the decon shower?

A little background for those of you not familiar with the "decon shower" in my title: I am referring to the decontamination shower that all Emergency Rooms are equiped with. It is basically a tiled room with large hoses that remind me of pressure washers. We would use such a room/ shower should a patient come in covered in a dangerous or flammable substance. Actually, there are many reasons why we might use such a shower... of which this is not about... so google it if you are interested.

There is not much worse than when you have been helping the nurse caring for a patient for a few days on end (remember that nursing is very "hands-on" with the patient), then you have a few days off that include sleeping in and lounging around the house, only to return to work and find that the patient that you helped the nurse with all last week is now in an isolation room because they have lice and fleas (and god knows what else).

First I cuss a little under my breath. Then I start itching all over. This is where the decon shower comes into play!! When I am done itching... which lasts the rest of my shift mind you... I go home, take a scalding hot shower, wash my hair till my scalp actually hurts, and sterilize everything I own. So much for sleep!

PAC-10 upset

#3 ranked USC just lost (in the final seconds) to the un-ranked Washington Huskies.

This is going to be a long season...

I know... I can relate...

At some point during almost every romantic comedy, the female lead suddenly trips and falls, stumbling helplessly over something ridiculous like a leaf, and then some Matthew McConaughey type either whips around the corner just in the nick of time to save her or is clumsily pulled down along with her. That event predictably leads to the magical moment of their first kiss. Please. I fall ALL the time. You know who comes and gets me? The bouncer.

— Chelsea Handler

Tell me you haven't been there... I dare you!!

I don't know my name... but I can read!

So this is not a recent story... but one worth telling (as per my friends).

Here is the background: I work with all different kinds of patients. From the young to the old... I kid you not... from 14 years old to 103 years old. (Those are my records to this date!). Caring for the spectrum of patients that I do... you see the differences in care that are required from one to the other. You also start to see a pattern in the different ages and sexes. For example... middle age men are the biggest babies about pain, regardless about the injury! But that is for another story. (And I'm SOOO not kidding... BABIES). Back to my story... I've discovered, in my non-scientific method, that old men and old women find 'confusion' in their own ways. They display their down slide into nightly confusion (sun-downing) in individual fashion. Old men generally undress and 'explore' themselves. Old women YELL out... what they yell is up to the individual.

So, to the story that my friends find worth a laugh. Generally, when a patient becomes 'confused' they can barely tell you their name. And if they do come up with their name, they usually assume that they are in their home and that there are some kids running around outside that they need to yell at. Usually they can't even tell you their name, and they have no idea what's going on... let alone read ANYTHING. So we had this >90 year old patient. This patient was clearly one of the smarter confused patients that we have ever had. In the middle of the night we suddenly hear "main menu" "main menu" "main menu" at a decible worthy of a football game. So what's caused it... the TV in the room has crashed and it's on the "Main Menu." Ok... so the patient doesn't know their name but they can read. A plus for sure. Shortly there after we hear "I'm thinking Arby's"... over and over again. Smart little confused patient... but I think Arby's is out of the question for you. At a loss we put the patient in a chair, in the hallway, at the nurses station. Suddenly... as the doctors are rounding on their patient... this patient yells out... at a decible level worthy of... say, standing in the engine of a lear jet at full throttle... "STROKE." So the staff runs to the patient... hello, we are in a primary stroke center.... "what do you mean? how are you feeling? what do you mean 'stroke'?" This patient looks at us and says "I'm feeling 'wildly' dizzy." Okay... lets get some vital signs and an assessment. Mid-blood pressure... "Help... help... help." Now I'm confused, I'm standing right in front of the patient talking to her. Then the patient points to the sign 0n the wall in front of her... "Stroke."

I lost 10 minutes of my life and about 2000 heartbeats. And now... I'm thinking Arbys.

Daytime TV

I've never been a big fan of television... a side effect of growing up in MY parents home. We always had a prescribed amount of time that my sibling and I could watch TV for... no more, ever! So I learned how to fill my time in other ways and it has stayed with me as I've grown into an adult. However... I often work the night shift in the hospital, leading to sleeping in the morning and then rolling out of bed to the couch around noon for some useless daytime TV. While I don't spend much time doing this... it's become a habit to watch a little TV while I work my way out of my stupor, brought on by my night shift working/ daytime sleeping schedule.

So I got up this afternoon around 11am and flipped the TV on and scanned the guide for something... anything to watch that does not involve Oprah, Dr. Phil, or Cops (I save Cops for the late night TV watching when I can't sleep!!). So I found a title that caught my eye... 'Wife Swap'. WTF... but I'll watch it, let the trainwreck begin.

So I just got up a little bit ago and I've already asked myself.... IS THIS FOR REAL? ARE THESE PEOPLE FOR REAL?

You got it!

Nursing school may be many years behind me, but a few things have been branded into my brain for all times. One such lesson was that when you greet a patient or client, you introduce yourself by name and title and you request their preferred name from them. To clarify preferred, I generally know the patients name, but often people go by nicknames or shortened names and I want to know what the patient prefers that I call them. Easy enough. Depending on the situation and the patient themselves I sometime have my own secret nickname for them, but they generally do not match the patients preferred name. Until today. BINGO... a patient and their nurse is on the same page!! So while I can't express to you how much I wish that I was the particular nurse taking care of this particular patient... I will have to live (and tell) vicariously through a co-worker!! The patient is admitted to the unit for a diagnosis that lends him to slightly forgetful moments and occasional strange behavior. None-the-less, the nurse enters the patients room and goes through introductions, then she asks the patient 'Robert' (all names and specifics/ diagnosis have been altered, but the stories are true) "What do you like to be called... Robert, Rob, Bob...?" The patient, who has been acting appropriate since the beginning of the encounter looks the nurse square in the eye and politely tells her, and I quote, "you can call me 'assh***."
Okay then... you got it. And now we don't need to bother with the secret nickname!