110 Hours Of Training

 

I loves me the kids that work for the local ambulance companies, most trying to become firefighter/paramedics, doctors, nurses, physician assistants, etc., but no matter what the Department of Transportation says, sometimes the brevity of their medical training leaves some rather largish gaps in knowledge and competence.

Case in point:

The other night, Local Ambo Co. crew brings in Mrs. Older Than Dirt from the local convalescent warehouse, for intractable pain.

Medic: "She's having intractable pain from an L-12 fracture."

ER Doc: *blinks*

ER nurse: "L-12?? Are you sure...?"

Medic: *looks at paperwork* "Oh, yes, definitely. Fracture at L-12!"

ER Nurse: "L-12...I see. Did she grow a TAIL...?" 

 

 

It Could Happen To Anyone

 A friend of mine who's a nurse caught COVID. Unfortunately for him he died, but even worse, he went to Hell. But as will come as no surprise to those who work in this profession, after he got to Hell, it was more than two weeks before he realized he wasn't still at work.

Halloween Notice

 

Worth A Try

MIA - Day 8

RON KLAIN - MISSING IN ACTION

MISSING

EBOLA CZAR

LAST SEEN OCT 21, 2014

ANSWERS TO "FLOUNDER"

REWARD IF FOUND

NO QUESTIONS ASKED

PLEASE CALL 1-202-456-1414 WITH INFO

WHITE HOUSE OPERATORS ARE STANDING BY

 

 

 

 

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A Little Link-Love: Represent!

Over on the right sidebar, you'll see a fairly short blogroll of medical/nursing blogs I regularly visit.

It's short because for whatever reason, nursing and medical bloggers simply don't last. They burn out, run out of words, time, or motivation, and then they quietly die on the vine one day. I've only been at this for about a year and a half, and I've already buried three of them, and a few more over there are on life support waiting for someone to pull the plug.

But under the heading of "A Picture Is Worth A Thousand Words" is one over on Tumbler that just seems to keep going and going like the Energizer Bunny:

                                                     What Should We Call Nursing?

If you want to understand nursing without getting a degree, and being elbow-deep in someone else's really vile bodily fluids on a holiday weekend at 3AM, go there.

The recipe is simple:
Take one Universal Nursing Truth, illustrate it with a short looped .gif/clip from somewhere in the culture - TV, movies, etc. - that didn't start out to have anything to do with nursing (but does in the right context), and get an essay on nursing that only takes about 1-3 seconds to grasp.

The results are, in a word, brilliant.
And more often than not, require a Beverage Alert, to avoid hot, cold, or carbonated fluids shooting out your nose.
I have lightened my mental load and killed a bit of time surfing that blog for a little humor when things quiet down on a busy shift. (Don't tell the hospital IT guys, that makes them crazy!)

I bring this up because the second current offering is Ebola-related. I missed it when it was new, because things have been a little busy at the keyboard lately. But since no small number of folks are tuning in here to stay current on the topic, it's appropriate. 

The site also chalks up "likes".
There are 702 for this particular offering, so far. As most of the visitors there are probably nurses, like myself, make of that informal poll what you will.

And the WSWCN blog deserves a long-overdue shout out anyways, so it might as well be for this.

Enjoy.

Mini Mental Status Exam: The Bathtub Test

During a visit to the psych unit, a visitor asked the director how they determine whether or not a patient should be institutionalized.

"Well," said the director, "we fill up a bathtub, then we offer a teaspoon, a teacup, and a bucket to the patient and ask him or her to empty the bathtub.

"Oh, I understand!" said the visitor. "A normal person would use the bucket because it's bigger than the spoon or the teacup!"

"No," said the director. "A normal person would pull the plug. So, would you like a bed near the window?"

Courtesy of Sean Linnane at Stormbringer

 

Not A&O, But At Least His Priorities Are Straight

College kid, suffering brief loss of consciousness after broomstick to head during broomball game at local ice rink, comes around within about a minute.

Witnessed questions first asked by patient immediately after regaining consciousness:
"Who am I, and who am I dating?"

Diagnosis Of The Week

Once upon a time, prior to entering nursing school, using the time-honored "try before you buy" approach, I took patient care out for a test spin. While doing volunteer patient care with some of the best medical professionals (paid or unpaid) I've ever been privileged to work with, we had occasion to do a lot of community events.

One especially notable one was an annual two-day air show which always drew upwards of 500,000 visitors for the two days. Because jets are cool, and entry was free.

The plus for us was, with that many bodies, we were going to get business. The minus for the city involved was, with that many bodies, there was no way they were getting an ambulance into the site, and even if they did, it would create more problems than it solved. So for everything from sore feet to heart attacks, we were it.

Mind you, were were up to the task, both from a personnel stand-point, to the fact that we essentially set up a 20-bed treatment area in the former airfield fire station, which became Airshow ER for those two days every summer.

But bureaucracies run on paperwork, so every year, after things wound down, the local supervisor of constables would come around, and get the low-down on the numbers and categories of patients we'd treated, for everyone from the airport manager to the mayor, and 27 agencies in between the two.

So one year, Fearless Leader is giving Lieutenant Doright the annual tally of victimology: 

"We watered 20,000 cups worth of participants;
 had 852 people needing sunscreen;
6 difficulty breathings, resolved;
2 chest pains, both transported by city fire; 
3 diabetic emergencies;
8 pedestrian-versus-airplanes..."

"Sorry, I thought the planes were parked. Did they run over the...?"
"Oh no, sorry, what happens is, the people are walking around the parked planes with missile racks hanging down and sharp wings and such, and not paying attention as they gawk, and they bonk into them headfirst.
 Where was I?...
okay, 11 foot injuries;
412 heat-related complaints, all recovered after treatment;
and 4 elderly patients FDGB."
"Sorry, what's an FDGB. I've got 20 years on the street, and I've never heard that one before from the city paramedics."

"Fall Down. Go BOOM!"
"Gotcha. Don't take this personally, but I think you guys enjoy this business too much." 



Dear Readers, from that day to this, one of my solemn healthcare missions in life is to make FDGB as commonly used and accepted as SOB, GSW, AAA, and countless other acronyms in the medical field. I didn't invent it, it's in the Public Domain, in fact it's even made it into the Urban Dictionary after 20+ years usage, but it accurately summarizes any number of medical runs and sign-ins that you'll see in the course of your career.

So I humbly request that you join me in proudly using FDGB, every time it applies.

Diagnosis Of The Week

Teenage male, suffering from closed head injury with no LOC, multiple contusions and abrasions, and two phalangeal fractures, secondary to testing out the nifty new 1/4 pipe plywood bike ramp he and his buddies built in the driveway, sans helmet, prior experience with helmets or ramps, or any other rationale for building it or trying it out other than "Because we could." Because 14 year olds are invincible and immortal.

Enterred onto tracker board as "Failure To Fly".

Attaboy from Rapid Track doc, golf clap from nurse, tech, and secretary.

Discharge Instructions: referred to warning on box of Superman Halloween costumes, given link to internet website of Hollywood Stuntmen's Association, and read riot act regarding lack of appropriate head protection.

Just doing my job, folks.

Groucho Marx Lives

We get into this job for the action and the trauma drama, but stay for the personalities and the comedy.

One night I'm sitting in my second home triaging patients, when one of our newer docs, jaded but not burned, whom I'll call Doc House, calls up front.

"What's this "foreign body ingestion" who signed in?"

"Oh, him...he swallows stuff all the time."

"How's he look?"

"Very stable. He's watching TV in the waiting room."
"Okay, what did he swallow tonight?"

"Lemme check the chart... He swallowed 3 quarters."

"3/4s of what?"

"Not three quarters OF something. He swallowed 75 cents."

"Gotcha. Call me if there's any change." <Click!>

Ba doomp. Tip your waitresses. Try the veal. I'll be here all week. Thanks for taking some of your time and spending it livening up my night, Doc.


Later on, I get shifted to the express zone for minor injuries and stoopid $#!^, and get to discharge The Swallower of Capistrano, whose abdominal x-ray reveals that he's got the makings of a small hardware store jangling around in his stomach. Airport security would probably pull him in for secondary screening every time when he sets off the metal detectors. Except he probably can't get to the airport, because he swallows his car keys.

But Doc House hasn't finished playing with this one yet. Handwritten note on top of the discharge instructions says:

"Attention Charge Nurse:
Please provide Mr. Capistrano with a taxi voucher to get home.
Do NOT give him bus tokens under any circumstances.
He'll eat us out of house and home!
            
 - Doc House

p.s. Feel free to give him directions to any of the 5 ERs closer to his residence than ours."

Yes. Yes, We Do.

Some people wonder if they can level with us, because they're worried we might, or absolutely certain that we are going to, laugh at them.

I could, of course, reassure you that everyone I work with is compassionate and professional, because no amount of money in salary makes it worth cleaning up both ends of you or sticking our hands inside your bloody guts to save your life, and yet we cheerfully do it, because we really are that compassionate and professional.

Some people will try to tell you that we're so compassionate and professional, we would never make light of ___________, because that'd be, y'know, wrong. And that we had our funny bones removed in nursing/medical school.

And if you believe that, just send me your credit card number and PIN, because I have a friend in Nigeria that needs a small investment to get $30,000,000 out of a bank there, which he'll split with us.

Look, you're in the ER because something happened (or you did it to yourself) and you can't fix it, or aren't sure it needs fixing, and even though you're afraid to tell us, you're more afraid of not getting it fixed. So you tell us.

And I absolutely promise, we won't laugh.

At least, not right now, or in front of you.

Because we're that professional, but we're not frickin' Vulcans. We see really crappy people, in crappy situations, and have crappy days, and sometimes - far more often than I'm happy with - if we didn't resort to occasional (and yes, a tad inappropriate if it was in your face) humor, we'd climb on an empty bed and start screaming hysterically, or just sobbing and sucking on our thumbs. So when you, and Fate, conspire to bring something snort-worthy and wave it right under our noses, you're damn skippy we're going to laugh. It's the garlic we wave to keep the soul-sucking vampires of depression out of our heads and make it to the end of another shift.

No, we aren't cracking jokes while we're doing CPR on the pulseless 97-year-old diabetic Alzheimer's patient with metastatic brain cancer whose guilty family has left him as a "full code". But what we do joke about does sometimes go beyond whatever tattered bounds of taste even the late late late night comic on Comedy Central would hesitate to cross.

One night - actually, so late it was early the next morning - an unfortunate man was brought into the trauma bay after being deprived of a goodly amount of his lower leg, amongst other and more critical complaints. A car is not a toy. It was grim and gruesome, partly because medicating his agonized moans hadn't gotten him to anywhere within shooting distance of bliss yet, which fact was audible to everyone within the department. It was even further grim and gruesome because all the supplies for starting IVs were kept in the trauma bay as well, and right next to them on the counter, delivered by the paramedics along with the patient, was a large tupperware pan, containing one tennis shoe, with a sock sticking out the top, then a section of calf sticking out of that, a bloody hunk of muscle above that, and finally half each of a bloody and broken tibia and fibia end poking out of that. Sitting on the other side of this ghastly table decoration was the young(er than me) trauma surgeon, deep in the midst of his pre-op notes to get the patient ready for imminent surgery, which almost certainly was not going to include the re-attachment of the battered and now extra appendage of Mr. Stumpy.

I don't know you, so maybe seeing severed limbs is part and parcel of your everyday, and you handle the sight with taciturn aplomb. I worked in the busiest and bloodiest ER on the planet then, and even to me, this was a bit out of the ordinary. And, being a movie fan, I stopped to process the I-can't-believe-I'm-seeing-this visual. As the surgeon turned to look at me across this flotsam of random anatomy, our eyes met for a second. I stared right into his face, and in my best Richard Dreyfuss tone of mock disgust and moral outrage, softly told him with utter solemnity that
"This is no boating accident!"
Then I immediately went back to rounding up the tubes and toys I came in to get.

And quick as lightning, trauma doc not only got the Jaws reference, he started to giggle. And couldn't stop for almost 5 minutes, even as he continued to write, and on the way out the door accompanying his latest charge to surgery. The patient, semi-delirious, and quite snowed in a haze of pain and opiates, never heard any of it. But I was quietly pretty damn happy that I'd lightened the load on a young doc's shoulders at 4 A.M. And didn't run screaming into the night myself, either.

Another place and time, a young father brought his toddler in for an unknown foreign body up a nostril. Come to find out, post removal, it was a big, BIG fat green table grape. Dad and doc marvelled at how on earth a three year old boy could have shoved a grape twice the size of the opening way up into his nose. But now, fixed up good as new, home they went.

Two hours later, dad came back, and signed himself in.
For a grape up his nose.

Thanks, ye Gods of Comedy.