You Don't Say.

We all have work lingo... in the health care field, the jargon can be particularly mind-boggling. On L&D alone, we drop acronyms all day, from PPROM, SROM, AROM... PTL, PUPPS... to IUGR, PIH, GDM and HELLP... from EFM, FHTs, LTV, IUPC, and FSE..... to SOL, PDI, ROP, LOA, and RC/S... along with Michelle Murray's brilliant and oft' repeated TFTF (too fat to fit!).

But it's the other phrases that fascinate me... the ones you won't find in any medical terminology text book, but which need no explanation among L&D staff.

A few examples that come to mind:

"They're wheeling her up from ER 'cause she's one-cheekin' it down there."
(Patient can't sit straight on the wheelchair. She's probably already pushing, so lets get a room ready for delivery.)

"She's got a positive wet wheelchair test so we're bypassing triage."
(We can be sure that her water broke because she's wet all the way through her pants and onto the wheelchair.)

"I think she's gonna need a little vitamin P."
(Her labor sucks, and it's time for some pitocin augmentation.)

"She's gonna need a zipper."
(She'll need a C-section.)

"She ended up delivering the vaginal bypass route."
(She had a C-section.)

"Can someone bring a glass of orange juice in for ______?"
(_____ is about to pass out... probably mid-epidural placement... and needs a little sugar boost.)

"Call the clinic doc to stand by."
(The patient's physician probably isn't going to make it in time for delivery, so get an attending nearby, just in case.)

Last, but certainly not least, the always-adrenalin-inducing:

"I need another set of hands in here!"
(Something's going down the tubes fast so somebody get your ass in here!... without completely freaking out the patient or FOB.)

Occasionally, this one is followed by:

"Tell them to open the OR!"
(self-explanatory.)

Truth is Stranger Than Fiction. Period.

HowManyOfMe.com

There are: 8 people with my name in the U.S.A. How many have your name?

So what are the chances that I would care for a patient with the same first and last name as me?

Because I DID. About 4 years ago, I was pulled to the antepartum unit for a four-hour stint, and one of the patients in my assignment was... me! Well, same name anyway. Slightly different age, way different skin color. Huh. I wonder what the statistical probability of that happening would be.

Give Thanks

It's a day to reflect on all that we are thankful for.

I am thankful for the calling to a noble profession dedicated to helping people.
I am thankful for the opportunity to make a difference in the lives of families every time I go to work.
I am thankful for the tremendous moment of birth when the ultimate outcome is truly out of our hands, that blink of an eye in which a tiny life begins... and is both completely dependent yet must breath and suck and pump blood all on its own.
I am thankful for the technology and advances in medicine that allow us to help sick moms and babes.
I am thankful that most deliveries require no such technology.
I am thankful for the team of dedicated nurses and other staff members with whom I work, the people who make work more than bearable, the ones who fill it with laughter, smiles and enjoyment.
I am thankful for the instances when there is no laughter or joy, when life is at its rawest and most real.
I am thankful that I can return to the loving, understanding arms of my family and a warm, inviting home.

Happy Thanksgiving.

the Sandman Cometh

I love to sleep.

As I snuggled between the covers and closed my eyes the other night, this thought superceded all others in my mind.

I love to sleep.

And night-time sleep is somehow so different than sleeping after working all night. I thrill at the chance to climb into bed along with the rest of the "normal" (i.e. daytime workers) world.

I'm not sure that people who exist primarily in the daytime can actually appreciate the extent to which a night-shift worker can long for sleep, the way we ache to stretch out and feel that release. Granted, I have a few kooky co-workers that only require a few odd hours of sleep after working a 12 hour night shift. I am NOT one of those people.

What can I say? I love to sleep.

Due to some scheduling changes, I have an extra stretch of nights off over the course of this week. While I would normally start to readjust to a daytime schedule at home on the same day that I have to go back to work, this week I have a few extra days of "normalcy". I feel like my perpetually foggy brain has cleared and that I have a ounce or so of energy and motivation when I usually would not. It's amazing how our circadian rhythms rule us. And how we throw them out the window for necessity's sake.

Night shift definitely has its perks. Lack of sleep is NOT one of them.

Food for Thought

How not to make friends with the Neo charge nurse: give her a 28 weeker, 30 week twins and then 30 week triplets over the course of about 4 hours.

Huh.

I'll try to remember that one next time.

Probably best not to mention the 26 weeker with a bulging bag at this point, huh?

Family Nurse Extraordinaire... otherwise known as a Comedy of Errors

As a nurse, you can and probably will find yourself appointed the Family Health Expert on any and all health-related topics.

I should know. I have spent the last day and a half proving the point.

It seemed simple enough at the start. Grandmother (GM) calls me and says she thinks she has a bladder infection and has been trying to reach her physician to call in an antibiotic prescription (I know, eyebrows raised) but just can't seem to get the phone call to go through. Little did we know, making the connection would be the least of our problems.

GM: "I listen and then I press 1 and then I don't know what happens."

I can just imagine... did I mention that GM is 99% deaf? She gives me the name of Her Doctor (a phrase we can use loosely here considering that she has seen him face-to-face ONCE... did I mention that GM also has a serious doctor phobia?). This physician has changed practices since she saw him... but, no biggie, right? (HA!)

me: What phone number have you been calling?
GM: "Um, I don't know... I can't seem to find it here, but that doesn't matter. It wasn't working anyway."

Uh-huh. Family Health Expert to the rescue.

I get through to the office without difficulty. However, it is now 12:32 pm and their lunch break started at 12:30. Perfect.

I call back at 1:30, and, after a brief explanation to the phone nurse, I'm given the phone number to Her Doctor's New Office. Okay.

Call to New Office.
Repeat brief explanation of situation.

Phone nurse: "We'll need to get GM's records transferred here and have her sign a release. Would she like to do that today?"
me: Ummm, considering that GM lives more than half an hour from your office and has a doctor phobia... no. (in so many words)

Call to Old Office.

me: Could you please fax pertinent records to New Office and GM will sign a release when able?

Thank goodness the answer was yes.
Call to New Office.

Phone nurse: "Oh look, we found GM's records. They were here all along because she signed a release when we switched practices. However, GM has never been here and Her Doctor is out of the office this week. We'll need to see GM."
me: Ummm, no. (insert brief repeat explanation of GM's doctor phobia and fact that she lives more than half an hour from New Office.) Can we please have her leave a urine sample at the hospital lab here in town?
Phone nurse: (and really, she was very accomodating, all things considered) "Let me check with Her Doctor's New Partner."

Apparently, Her Doctor's New Partner does not have priveleges at the hospital here in town, so one way or another GM would have to drive to the next town up in order to get any help from New Office. ARGH. (That last part was unspoken, but definitely heartfelt.)

Next step, half hour conversation with GM regarding whether or not to stay with Her Doctor and drive to New Office out of town, or switch to someone else at Old Office here in town. After much hemming and hawing (I'm talking MUCH here... due to GM's hearing difficulties, I must repeat virtually every sentence at least once), GM decides to switch to someone else at Old Office. Okay, now we're getting somewhere.

Call to Old Office.

me: Hi, it's me again. GM would like to switch back to your practice (I can almost see Phone nurse rolling her eyes at this point)... would it be possible for her to leave a urine sample at the hospital here in town so that she can have an antibiotic called in if necessary?
Phone nurse: "Yes, but you see, we no longer have GM's records, so she'll need to sign a release and have them transferred back from New Office."
me: (muttering under my breath for a moment...) Okay.

Call to New Office. (by this time I'm not even sure who's who... I'm just glad they're still willing to take my calls.)

me: Hi, it's me again. GM decided to seek advice at Old Office. Could you please fax pertinent records there?

Again, the answer was yes. Sigh of relief.

Next step, explain to GM that we still need a urine sample. If she drives to my house, I will take her to the hospital lab where she can give one. No problem.

I proceed to wait for another half an hour or so, expecting GM to show up at my house. At this point, she calls me.

GM: "Well, I got about halfway to your house and it got really foggy. I started thinking about how long I'm going to have to sit in that doctor's office, and I really can't be driving home in the dark. So, I turned around and came home. I think I'll just wait it out. After all, it's not really that bad."
me: (pause for silent scream) GM, I really think you should do this. I'll come and get you. And you won't have to sit in the office. We're just going to go in so you can pee in a cup (at this point, I really did use the words "pee in a cup" with my Grandmother... yikes.).
GM: No.

Call to Old Office.

me: Yeah, it's me AGAIN. I'm very sorry. You're not going to believe this, but GM does not want to come in today. She agreed to call or come if anything gets worse. You see, she's got this doctor phobia...
Phone nurse: You know, I think I remember GM.
me: I bet you do.

End of story, right? Wrong.

Over the course of that evening and the next morning, there were a few intervening phone calls from GM, reassuring me that she's feeling just fine and thinks that her discomfort will probably go away if she keeps up with the water and cranberry juice, also informing me that "if it gets really bad in the middle of the night, I'll just call 911." She said it so matter-of-factly that I really thought she was kidding. Not so. And I'm fairly certain that I did not dissuade her from that plan, despite my attempts to make her promise to call me if anything were to happen during the night. ("Oh, I wouldn't want to wake you up!" Little does she know, I'll probably lie awake anyway, wondering if the fire department is being summoned to the home of a little 88-year old woman with a UTI.)

So, next morning... not half an hour after calling to inform me again that she's feeling just fine and she'll call me if anything changes, she calls back and says that she was talking to a friend who informed her that the weather is supposed to be nasty for the next few days, and perhaps she should just give the sample and get it over with before she can't get through on the roads.

me: (gasp of disbelief and slap to forehead...) Well, sure. (thinking, Why didn't I think of something like that?!)

After all that fuss, GM came to my house and we went to the hospital lab and she gave the sample.

End of story.

For now.





Thanks to Dr. Dinosaur and the link to him at Grand Rounds for a little inspiration this week. :)

Not Enough and/or Too Much to Say

Am I the only one who's gotten so intimidated by the excellent medical bloggers out there that I've developed a severe case of writer's block?

Ugh.

Please refer to the links I've posted on the sidebar for bloggers who have many worthwhile and insightful things to say...

And, yes, I realize that I haven't even been at this for very long. I'm just trying to find the right rhythm and groove, struggling not to make a fool of myself.

Forgive the blatant whining. Hopefully I'll be back with something worthwhile.

And, yes, it's also a case of life-long, eldest-child perfectionism. Sometimes you just have to laugh at yourself.

I've been busy.

From the Merriam-Webster Dictionary:

Main Entry: hi·a·tus
Pronunciation: hI-'A-t&s
Function: noun
Etymology: Latin, from hiare to yawn -- more at YAWN
1 a : a break in or as if in a material object : GAP b : a gap or passage in an anatomical part or organ
2 a : an interruption in time or continuity : BREAK; especially : a period when something (as a program or activity) is suspended or interrupted b : the occurrence of two vowel sounds without pause or intervening consonantal sound

Can the word "yawn" be contagious when read?

As the day charge nurse aptly put last night upon my arrival, "Everything was going okay until 4:00pm, when the skies opened up and started raining pregnant women!" Well, the day nurses this morning came on to a very nice board, due in large part to the fact that we delivered the whole flood of patients that were left to us, along with another wave that followed.

Note to self: do not EVER make comment to departing shift based upon the current census on the floor along the lines of "Well, it must have been a good night (or day, as applies to situation)... you're all just sitting around." The fact is, we got our butts kicked and then did it all over again a couple of times and right now we're sitting here staring at each other because every ounce of energy we may have had is completely gone.

On that note, nighty-night!

Now, That's What I'm Talkin' About!

One of our anesthesiologists had a relative in labor last night. The guy must have learned a thing or two in all his years of practice... he magnanimously slipped a wad of cash to one of the nurses at the desk and had her order pizza for everyone on (have I mentioned that we have at least 20-25 nurses working L&D at any given time?).

Good man.

Ewwwwww!

This RN's definition of "gross".

We each have our own niche, our own interests... our own comfort zone. For registered nurses, the sight of blood and body fluids, parts and procedures is typically less gruesome than it may be for the lay population (I hope). However, even within the nursing universe, that which turns our stomachs and leaves us feeling green can vary widely.

For instance, I'm comfortable with vaginas. (I'll spare you the visual aid here... I said I was comfortable with them. Doesn't mean I think they're worth looking at.) I have no qualms about saying that. And it's a good thing, for obvious reasons. In obstetric nursing, and particularly in labor & delivery, the vagina is simply a means to an end. A few of my friends from nursing school have said, "How can you handle that, down there?" Even patients are occasionally embarassed about nursing care they receive, such as the intimate care that we may have to assist with in the bathroom after delivery. I've had more than one patient comment, "You must really hate this part of your job." It's difficult for me to explain and probably even harder for them to understand, but those things just don't bother me.

However, there are some things that do.















I think eyes are YUCK. Not to look at from across the room. Not to gaze into on the countenance of your loved one. To examine, to touch and to fix. I'm fortunate enough to have good vision and have therefore never needed glasses or contacts. Thank goodness, because I'm pretty sure regular eye exams would kill me. As luck would have it, one night at work, we were discussing the benefits of laser eye surgery and I mentioned my eye phobia (it went something like, "Argh! Stop talking about that! Eyes are so gross!"). No joke, a few hours later I somehow managed to flick a piece of plastic into my eye. After trying desperately for half an hour to stop blinking and tearing like a faucet, my coworkers convinced me to go downstairs and have it checked out. An hour later, you would think I'd been purposely sent to the ED for a course of torture... first the numbing drops, shine a bright light in my eye, wait for the numbing drops to work, put orange liquid in my eye, shine an ultraviolet light in my eye while my head is being held still with a big metal contraption, wait for the attending, shine the ultraviolet thingy again and both come up with the brilliant conclusion that "That's a BIG corneal abrasion. It must hurt!" Thanks. And YUCK. Just gimme my Vicodin and erythromycin, and I'll blink my way back up to OB.




Not much further to the south is the mouth. I give dental hygeniests all the credit here... just as I'm often the one who gets to push for three hours with a patient so that the physician can come in with a catcher's mitt and look like the hero, the hygeniest is the one who gets to do all the picking and plucking, rinsing and buffing so that the dentist can take a peek in there at the end of the appointment and declare the state of tooth health or decay. Blech! I can't imagine what it's like when they get a really nasty mouth. And I've seen them... fortunately from a safe distance!






Somewhere around the middle is the belly button. Now, I realize that this one is totally irrational. Be that as it may, I have a total phobia about belly buttons... my own in particular, and those of others as well. I have good reason for appreciating it's functionality for babies in utero and once born. However, the fact that there's still a hole there... ugh. Anyone who's had to prep an abdomen for surgery and used the big ol' Q-tips specifically made for "cleaning out" that particular little breeding ground can perhaps appreciate that it really makes me want to gag just thinking about it! What else have you got hiding in there?




And finally, at the bottom, feet. Double-YUCK! One of the residents felt the need to elaborate on his athlete's foot problem the other night, and I just about started gagging right there at the desk. Thanks for sharing! Check out the Foot Blog for more gory details. I give foot docs a lot of credit for "going there". Ew! I prefer to ensconce my feet safely in their Dansko clogs and not think about what might be going on in that warm, little night club between my toes.

There you have it. My definition of gross. Totally irrelevant to nursing practice or theory. I guess we can file this one under "amusement." (See my first post.)

It's important to know yourself and what you can (and can't) handle. Anyone care to add to or elaborate on the topic? What is your definition of gross?