I can peg a Maury Povich or a Judge Joe Brown watcher from a mile away. Or really, just from the doorway to their hospital room. My accuracy is around 97.82%. I could write an entire Sociology textbook around the television shows that various demographics watch while in the hospital. I work with adults. Some adults watch cartoons, like Spongebob. Some watch the Disney Channel. A lot watch trashy talk shows. Some watch judge shows. Some even watch FOX News!!
Yesterday my assignment included two tracheostomies. There are no hard and fast “rules” on our unit about assignment limitations. Mostly we just divvy up the isolations, the total cares, the trachs, the chest tubes and the needy as fairly as possible among the nurses. Usually a nurse will only have one trach. 3 isolations at the most. A couple of chest tubes is no big deal. One total care is plenty. Usually it works out, sometimes you get screwed.
Some nurses complain more than others about their assignments. Some nurses don’t even bother to put their things down when they come in to work in the morning but rather head straight over the the assignment sheet with their purse/bag, lunch, coffee and phone in hand to make sure they didn’t get an unsavory assignment that day. Some nurses bitch and grumble if their assignment isn’t perfect, like with 5 walkie-talkies. I tend to figure, eh, what goes around, comes around.
Yesterday was a “come around” day for me. Two tracheostomies, one with a deep oral flap that required frequent checking but that I could barely see because she couldn’t open her mouth farther than a finger’s width. A total care with diarrhea (jackpot!) and an 80 pounder with a stage III. If given the choice between that assignment and a root canal yesterday, I would have strongly considered the latter.
My second one wasn’t a technically difficult trach. His secretions were thin and manageable and he didn’t need frequent deep suctioning like my other one did Which is probably why I got the two and everybody else only got one. Nurses are like the opposite of greedy kids at Christmas. “How come I got two and Johnny only got one!?…I only want one!”.
The Easy Trach, we’ll call him, was progressing nicely towards decannulation (taking the trach out and taping up the hole in their neck and letting them breathe through their upper airways again). Yesterday was time for cuff deflation and speech trials. Without getting into the anatomy & physiology of your airways and vocal folds just remember the following easy equation. Cuff up = no talk. Cuff down + Passey Muir speaking valve = talk.
I had been having difficulty with Easy Trach that morning while his cuff was up because in addition to being the worst lip speak enunciator, he had horrendous handwriting/spelling/grammar. He lip spoke too fast and when I couldn’t decipher I asked him to write down what he was trying to say. So he’d write down one word (“medasin”) and then continue to rapid fire lip speak the rest while pointing a the clock. After about 5 minutes I finally was able to figure out that he wanted his pain medicine precisely at 8am and not a second later. The morning went on like this with him lip speaking too fast, me asking him to write it down, him writing one or two “words” down and then lip speaking the rest. I was desperate to deflate his cuff so we could communicate better.
When it finally did happen, everything made sense to me. He was a talker. A fast talker. And he wouldn’t shut up. I wanted to immediately re-inflate his cuff. “Let’s just put this cuff back up, shall we hmm?”
I’m not talking about preschoolers. I’m talking about a large prostate and a small penis. And my semi frantic attempt at placing a catheter to drain the 1200cc of urine that has collected faster than a flash flood.
I don’t judge. Every peen gets my due respect regardless of size. Until they reveal their nasty hidden secret…a bulbous flesh gate half way to Graceland that’s stopping that slippery rubber catheter from giving certain relief. It’s like trying to shove an asparagus spear through a watermelon.
And then your hands get covered in lube because you’re keeping your non-sterile (dirty) hand on the peen and your sterile hand on the catheter while trying to push it in and not lose ground when it pushes back out. Then the shaft starts slipping through your dirty hand like a clam neck into its shell, and you think “screw sterility” and you transfer it into the last 3 curled fingers of your dirty hand and use the thumb and index finger to anchor the catheter while you continue to fight with the prostate. All the while sounding like a yoga instructor…”now breathe…good…and relax….and take a deep breath…and exhale”.
And when at last I get it in and that liquid gold begins to flow, we both breathe a sigh of relief. The patient because the worst trauma of his life is over, and me because I don’t have to page the urology resident with my tail tucked between my legs and ask for backup.
Trying to remove a long forgotten, embedded suture with tweezers and a scalpel is like trying to find the lost end on the roll of plastic cling wrap. I need a monocle.
Sometimes I hate the word “nurse”. Usually because its a patient yelling the word from down the hall because they’ve forgotten how to use their call light. Or using it instead of my name. Like at the end of my shift yesterday. I’m doing my rounds, making sure everything is ship shape for the next shift & everyone is alive etc., and my patient says, “oh nurse, the ice melted in my water”.
[blank stare]. By me. I mean, technically I don’t have to answer that. It’s not a question. But…
First: Is it necessary to use the word “oh” in front of nurse? Are we speaking in sonnets? Or iambic pentameter?
Second: It won’t kill you to polish off that water sans ice. Or perhaps you would like a lemon slice when I bring the ice? A lemon slice which I will desperately resist squirting on your surgical wound. But lets not get carried away.
And third….you really don’t remember my name after 12+ hours? I mean…I remember your name, and I memorized pretty much every important detail about your body & your health. And of my four other patients as well.
Guess I’m just not that memorable. *sniff*