When my patient actually says “Thank you” for something.

Image

oprah gif

Advertisements

Abdominal pain & nausea = a burger and coke?

Seems like that sentence is backwards right? It should be “a burger & coke = abdominal pain.” Except last shift it wasn’t. Patient with long standing abdominal pain & nausea of unclear etiology (read: there’s no organic or radiological evidence to suggest a reason for the abdominal pain) with multiple ER and hospital admissions for IV pain control and GI rest. So we throw the bus at her: nasogastric tube for GI decompression/rest (refused), nothing by mouth (complained), IV Dilaudid for pain (Yay!), encouraged mobility, because believe it or not, your gut likes you to walk (refused). Flash forward three days when she finally wakes up out of her stupor when docs decrease her narc dose and lengthen the amount of time in between doses (irate!) and liberalize her food options (your food sucks!). This is generally how these stories play out. And yet I surprise myself because I still get surprised when the first thing they order after DAYS and DAYS OF PAIN AND NAUSEA is a cheeseburger and coke. Two cokes and “put this one in the fridge!”

It’s like a hip replacement wanting to do yoga or a triple bypass itching for some cross fit the day after surgery. Doesn’t happen like that. So if this sounds like you…at least try and fake it, for my sake. Order some jell-o first.

Nursing and waitressing

I waited tables and bartended to pay my way through nursing school. I remember thinking, during particularly busy dinner shifts with customers who were high maintenance or angry or demanding or just determined to be unsatisfied, that things would become SO much better when I graduated from nursing school and became a real nurse. NOBODY would order me around, treat me like a servant, talk down to me, attempt to make me feel inferior or repeatedly send me back to the supply area for extra condiments. NOBODY! I would be the EXPERT! I would have POWER! (that I would wield responsibly of course…)

Surprise! Ten years later…I get ordered around, treated like a servant, talked down to, attempted to be made to feel inferior, and repeatedly sent back to the supply room for extra condiments. Except the condiments are drugs. Lots of ’em.

Graduate School….

…has kept me from storytelling. I’m in graduate school full time in a Doctor of Nursing Practice program. I’m also still working pretty much full time. So betwixt the two of those…well sometimes I don’t even have time to pee. But maybe there’s still hope for this little thing. I’m toying with the idea of just writing smaller posts. A paragraph maybe. Because the stories are still happening (claw arms, “what channel is HBO?”, the thing that looked like a purple grapefruit, “there’s a Skittle in my poop”, organic vegan celiac menu) I have a few additional sources of rich content as well, thanks to my fellow students. There’s always that one with all the questions…

Shift Change

Getting an admit within the hour before shift change is like going to any business 5 minutes before closing and making a huge high maintenance order.  Like a Starbucks run for your entire office floor and everyone wants a different kind of milk: soy, nonfat, almond, whole, 2%.  And doing it right before closing as they’re mopping the floors and cleaning out the pastry cabinet.  And also…doing it while you’re drunk.  That was my ED admit last night at 1845.  With a 240mg/dL blood level and a bunch of stat orders.  Why someone, who is only being admitted to sober up and so I can bandage a minor head lac, needs stat orders is beyond me.  Actually, sadly, it isn’t.  I just read a journal article about someone in an ED who came in completely wasted & the staff didn’t search his belongings thoroughly enough to find the cigarettes and lighter that he then proceeded to light up and smoke.  And then somehow manage to set himself on fire.  And then sue the hospital.  And win.  Apparently he needed stat orders.  “Smack upside the head, Q15minutes PRN STAT!” 

 

This field…

This field of work makes me, amongst other things, have no boundaries when it comes to all things gross.  When people throw around the acronym “TMI”… I’m like… “What’s that?”  Because, really, nothing is TMI for me.  I’m in the business of inquiring about that much information.  When was your last bowel movement? What was its consistency? What color is that discharge? Does it smell bad?  Do you practice protected sex?

So it is no big surprise that this also applies to my personal life.  Things that I’m quite certain should gross me out…don’t.  (with the exception of bathtub drain hairballs…I’d rather rip out my fingernails one by one with a rusty pair of pliers and then dip my hands in lemon juice and battery acid than snake the drain after a month of my showers)

Case in point this morning.  We feed our cat twice a day.  And he acts like we’re starving him.  There’s no real need for an alarm clock, as he is already tromping all over the bed demanding to be fed by 0530am.  And I have yet to hear him chew any of his kibble.  I’m certain that if I dissected him soon after a meal that I’d be able to package up his stomach contents and sell it at the farmer’s market as organic soft kibble.  And make a fortune.

So this morning as I’m feeding him I realize we’re running low on cat food.  Which means a trip to Costo on Sunday which I hate.  I’d rather… well, you get the point.  So he inhales it in a very ungentlemanly pace and manner.  And then as I’m getting dressed I hear the sound that every cat owner knows.  I don’t even know how to spell it.  “Whomp, whomp, whomp ….eeeccchhhh”  I just hope he’s not on the area rug.  A whole house full of wood floors and he manages to get it on the area rugs about 96% of the time.

So there it is, right next to his feed dish.  A little pile of freshly regurgitated cat kibble.  Right next to his feed dish.  And we’re running low on cat food.  Waste not want not, right?  So I scoop it up in a paper towel and empty it right back into his dish and go on about my morning.  And he ate it.  And he’s been sitting on the easy chair grooming himself ever since.  Maybe its better the second time around. And he almost could have enjoyed my husband’s breakfast the second time around too. From now on I’ll make sure he’s not in the room when I recycle the contents of the cat’s stomach.

Pronunciation & slang

One pet peeve of mine is mispronunciation of medication names.  And unnecessary slang usage.  From both patient and provider.

As a provider, I think it is essential that we be able to pronounce medications properly.  Yes, there are a lot of medications with tongue twisting names, but every medication reference book has some sort of dummy instructions (pro-pee-sha, vie-ah-gruh).  Besides…how confidence inspiring is it to have your nurse butchering the names of the medications he/she is giving you? Not at all.

I mean, if my barista called out my caramel macchiato as “care-mall match-ee-ay-tow”  as opposed to “car-mul mach-ee-ah-toe” I’m pretty sure I’d think they were on their second day of barista training and that if they can’t pronounce it, how can they possibly create it?  And that’s okay really, because caramel macchiatos can’t kill you.  But carvedilol maybe can, or digoxin, or lorazepam.

And slang.  Oh slang.  Just as I don’t walk up to my barista and order a “cuppa joe” or “jet fuel” or “mommy’s milk”, I refuse to be asked for “oxy”.  We’re not on the streets here.  I’m not selling it to you.  I’m administering it.  So call it by its proper name, thank you.