To those of you day-shifters that are grumbling about the shortened night tonight, all I have to say is,
"Hoo Hoo Hahahahahaha!"
(Smug grin.)
We earned it.
See you bright and early tomorrow morning!
Showing posts with label tongue in cheek. Show all posts
Showing posts with label tongue in cheek. Show all posts
Saturday, March 10, 2007
Wednesday, January 31, 2007
Girls Just Wanna Have... Babies.
You know her. She's the labor-wannabe. Let's call her Labor Girl.
******
Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. This must be it!
Her husband, let's call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. What have I gotten myself into?
But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. This is going to be fun!
She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.
******
Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.
Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.
******
Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.
******
Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. This must be it!
Her husband, let's call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. What have I gotten myself into?
But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. This is going to be fun!
She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.
******
Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.
Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.
******
Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.
"Well... I'd rate these contractions about 6 or 7 on the pain scale." Straight face. It's that darn pain scale again.
******
Bad news.
"I'm only dilated to 2 cm?"
Labor Girl is clearly disappointed.
Doubt begins to curl around the edges of her optimism.
"Are you going to send me home?"
******
After a short while, the monitors are removed, and Labor Girl begrudgingly goes for a stroll. This isn't as fun as she had anticipated. Who wants to go for a walk at 2:30 in the morning? Another wave of doubt crests. Maybe if I walk a little faster.
******
Round and round she drags Dear Hubby, whose exhaustion has overtaken his fears.
The nurses smile understandingly each time the determined couple rounds the corner. Does Labor Girl think this is a race that she can win? That if she makes it through the hallways quickly enough or does enough laps, then we'll keep her?
******
It's time to be rechecked.
"Yes," Labor Girl nods to the nurse. "The contractions feel much stronger!"
She holds her breath, awaiting the verdict.
"I'm still 2 cm?!"
******
And now, here it is: the Walk of Shame.
Poor Labor Girl.
She trudges out the doors, pouting, vistaril in hand. How can this NOT be it?
Dear Hubby gathers the belongings and follows her solemnly home. Thank goodness this wasn't it.
******
And so, you see, sometimes no matter how badly you want it, labor it is not.
Maybe next time, Labor Girl.
I'm sure we'll see you soon...
Thursday, January 18, 2007
Ouch!
I'm thinking of changing the way in which I describe the pain scale to patients before asking them to rate their pain.
As a small part of the volumes of charting we are required to do for every patient, we must enter a digit into the computer, detailing where on the pain scale the patient is rating their pain. Then, we're able to reassess the pain at various intervals, and determine whether or not interventions used to ease the pain have been effective. Great, in theory.
This is how I usually phrase the question: "So tell me, how would you rate the pain, on a scale from zero to 10, zero being no pain, 10 being the worst pain you can imagine?"
Key word, imagine.
Apparently some of my patients suffer from a grave lack of imagination.
Imagining that "worst pain" seems to be a difficult concept to grasp, despite my assurance that this is not about whether you have experienced severe pain in your lifetime and how your current pain feels in comparison. I understand that if you've never been in labor, never had a serious injury, never had major surgery, it can be hard to imagine that kind of intense pain. But seriously, TRY.
Do patients think that I find it amusing that they rate their pain "11" out of 10, when they're conversing with their friends and answering their cell phone, whilst the poor woman across the hall can barely utter "7-8" out of 10 while she sweats and groans and writhes on the bed? And I'm not talking about some ultra-stoic multip. Often, it's the first-timers who like to think that early labor must be as bad as it can possibly get. As I said, key work, imagine. Otherwise, it just defeats the purpose.
The thing is, I really don't intend to judge others on their perception of pain. I frequently elaborate on the fact that we all experience pain differently, and that the pain scale is intended to help us monitor "where we go from here." But it is useful to have a somwhat accurate picture of the current pain level and perceived intensity of pain for each individual patient. Chances are, if you can chat and laugh through a contraction... it's not that bad. Some patients will even go so far as to keep one eye on the monitor so that they will know when they are contracting and can be sure to act accordingly. Believe me, if you're really in labor, you don't need the monitor to tell you when the pain comes!
Apparently, I need to rethink my assessment technique on this one.
How would this work? "So tell me, how would you rate your pain on a scale from zero to 10, zero being no pain, 10 being the pain you would experience while being run over by a steam roller?"
I wonder what kind of a response that will evoke. Probably wouldn't be making too many friends.
Another tactic...
The New-and-Improved Labor Pain Scale:
1. "I think someone just pricked me with a pin, but I can't remember exactly where because I can't feel it anymore."
2. A twinge of pain that's definitely there, but quickly forgotten.
3. Headache pain that is distracting enough, but treatable with a little ibuprofen and a cup of coffee.
4. "Whew, that pain was pretty bad, and made me stop in my tracks and breathe for a minute."
5. Now, c'mon girls... I know not everyone experiences period cramps, but who has never had really bad diarrhea, when you think the cramps are promptly going to expel most of your bowels, along with their contents?
6. When you stub your toe so hard, you're fairly certain it's broken, and probably won't be able to walk on it for a day or so.
7. I have dislocated my shoulder, so I speak from experience when I say that this worth at least a "7" on the scale... that feeling of almost having torn one of your limbs from your body.
8. I've heard really bad back labor described as, "It feels like the baby is trying to come out through my tailbone, like my body is ripping itself in two!"
9. Being dipped in boiling oil... not sure, but this seems like it would be unbelievably painful.
10. Last but not least, the aforementioned steam roller/crushing experience.
Now, some of these are open to interpretation and finesse, but I think perhaps I'd get a more accurate assessment of the patient's pain if she were obligated to take this scale into consideration. Anyone else have fun ideas or suggestions to work into the scale?
***I know... seriously tongue-in-cheek. C'mon, tell me you've never rolled your eyes when your patient rates their pain an "8" out of 10, only to turn around and ask for a sandwich and "How long is this going to take?"
As a small part of the volumes of charting we are required to do for every patient, we must enter a digit into the computer, detailing where on the pain scale the patient is rating their pain. Then, we're able to reassess the pain at various intervals, and determine whether or not interventions used to ease the pain have been effective. Great, in theory.
This is how I usually phrase the question: "So tell me, how would you rate the pain, on a scale from zero to 10, zero being no pain, 10 being the worst pain you can imagine?"
Key word, imagine.
Apparently some of my patients suffer from a grave lack of imagination.
Imagining that "worst pain" seems to be a difficult concept to grasp, despite my assurance that this is not about whether you have experienced severe pain in your lifetime and how your current pain feels in comparison. I understand that if you've never been in labor, never had a serious injury, never had major surgery, it can be hard to imagine that kind of intense pain. But seriously, TRY.
Do patients think that I find it amusing that they rate their pain "11" out of 10, when they're conversing with their friends and answering their cell phone, whilst the poor woman across the hall can barely utter "7-8" out of 10 while she sweats and groans and writhes on the bed? And I'm not talking about some ultra-stoic multip. Often, it's the first-timers who like to think that early labor must be as bad as it can possibly get. As I said, key work, imagine. Otherwise, it just defeats the purpose.
The thing is, I really don't intend to judge others on their perception of pain. I frequently elaborate on the fact that we all experience pain differently, and that the pain scale is intended to help us monitor "where we go from here." But it is useful to have a somwhat accurate picture of the current pain level and perceived intensity of pain for each individual patient. Chances are, if you can chat and laugh through a contraction... it's not that bad. Some patients will even go so far as to keep one eye on the monitor so that they will know when they are contracting and can be sure to act accordingly. Believe me, if you're really in labor, you don't need the monitor to tell you when the pain comes!
Apparently, I need to rethink my assessment technique on this one.
How would this work? "So tell me, how would you rate your pain on a scale from zero to 10, zero being no pain, 10 being the pain you would experience while being run over by a steam roller?"
I wonder what kind of a response that will evoke. Probably wouldn't be making too many friends.
Another tactic...
The New-and-Improved Labor Pain Scale:
1. "I think someone just pricked me with a pin, but I can't remember exactly where because I can't feel it anymore."
2. A twinge of pain that's definitely there, but quickly forgotten.
3. Headache pain that is distracting enough, but treatable with a little ibuprofen and a cup of coffee.
4. "Whew, that pain was pretty bad, and made me stop in my tracks and breathe for a minute."
5. Now, c'mon girls... I know not everyone experiences period cramps, but who has never had really bad diarrhea, when you think the cramps are promptly going to expel most of your bowels, along with their contents?
6. When you stub your toe so hard, you're fairly certain it's broken, and probably won't be able to walk on it for a day or so.
7. I have dislocated my shoulder, so I speak from experience when I say that this worth at least a "7" on the scale... that feeling of almost having torn one of your limbs from your body.
8. I've heard really bad back labor described as, "It feels like the baby is trying to come out through my tailbone, like my body is ripping itself in two!"
9. Being dipped in boiling oil... not sure, but this seems like it would be unbelievably painful.
10. Last but not least, the aforementioned steam roller/crushing experience.
Now, some of these are open to interpretation and finesse, but I think perhaps I'd get a more accurate assessment of the patient's pain if she were obligated to take this scale into consideration. Anyone else have fun ideas or suggestions to work into the scale?
***I know... seriously tongue-in-cheek. C'mon, tell me you've never rolled your eyes when your patient rates their pain an "8" out of 10, only to turn around and ask for a sandwich and "How long is this going to take?"
Tuesday, November 28, 2006
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.)
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.)
Thursday, November 16, 2006
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. :)
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. :)
Thursday, November 02, 2006
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?
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?
Monday, October 23, 2006
Welcome to OB Triage
Sometimes I'm convinced that the management and physicians have conspired to place a glowing sign at the ER entrance that states (in large flashing pastel pink and blue letters), "All pregnant freaks and their families, WELCOME! C'mon in to OB Triage" To top it off, the sign is only lit during the most inopportune (i.e., already busier than crap) times.
Case(s) and point:
You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.
You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.
You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.
You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)
You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.
You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)
Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.
Hey, at least I still got my health.
Case(s) and point:
You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.
You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.
You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.
You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)
You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.
You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)
Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.
Hey, at least I still got my health.
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