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!” 

 

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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.

“Really?”

I use that word a lot, every day.  And not in a genuine, inquiring sort of way.

I use it in an annoyed, “of course this would happen right now” sort of way.  No upward inflection at the end of the word that indicates a question.  Simply monotone, almost as though it were punctuated with a period.  “Really.” The equivalent of slapping my palm to my forehead.

My nurses aide – “amostlyseriousnurse, Mr. J just pulled out his NG tube as I was standing there”

The nurse on my end of the unit – “amostlyseriousnurse, it’s 1.5 hours into my shift and I’m going for a coffee break.  Can you watch my group?  I have someone’s PCA that’s about to run out and will need to be changed, someone coming back from CT who needs 4 people to transfer and I just put someone else on the bedpan.  Oh, and my nurse’s aide is also going on break.”

The doctor I wouldn’t trust to cut my toenails – “amostlyseriousnurse, do you have Mrs. X? I’m not seeing any respirations, can you come verify?”

The phlebotomist – “amostlyseriousnurse, Mr. P is refusing to have his blood drawn.”

The lady who delivers the meal trays – “amostlyseriousnurse, I have a tray for the reverse flow isolation room that you just left.

I just need a sign hanging around my neck that says, “Really” and I’ll do the palm to forehead.

Code Strong, Urology.

Every hospital probably has their own “code” lingo.  Code blue, code 4, code Adam, code brown.  It’s usually an overhead page heard round the hospital that alerts particular team members of an urgent situation.  Like someone choking on a big bite of cafeteria Philly Cheesesteak (“Code blue, cafeteria!), or someone tripped and fell & couldn’t get up as they were walking up to admitting (Code MET valet parking) or someone was found pulseless/apneic in their hospital bed and needed resuscitation (Code 4, 8East) .

My personal favorite is the code strong, which is our overhead code call for security “show of force”.  Show of force is basically several security officers showing up to the scene and trying to intimidate with their sheer numbers…usually two to three in these parts.  Really intimidating.  Typically, its the patient coming down off their high or sobering up and wondering where the fu*k they are and starting a fight with the first person they see.  Sometimes its the sweet little old man who’s post op from a prostate resection who goes delirious from anesthesia & suddenly acquires superhuman strength  & demonic possession and rises out of bed a la Linda Blair intent on “getting out of this damn hotel & back to the fish hatchery!!” (yeah buddy, you’re not the first or the last person to think this place is a hotel, and that I am a waitress).  Then the sideshow really begins.  Within about 5 minutes of calling a code strong, our ragtag bunch of security personnel with their flashlights and 8lb jangly key rings hanging from their belts show up.   The security team usually consists of the the 5’1″ token woman, the 64 year old close-to-retirement-osteoporosis-limper and the overweight early 20’s first job huffing/puffing as he gets to the room.  They all show up, a royal circus ensues, and you just pray that nobody gets their fingers broken or their tubes yanked out.

My personal favorite , as of late, is “Code strong, Urology clinic”.  We stand around, after getting a good chuckle, tossing around possible scenarios that would require a security show of force in a urology clinic.

Surely it’s a man.  With a penis.  Who doesn’t want anything or anyone coming near it with anything resembling a hose, needle or knife.

The surgeon seamstress

The day after Halloween, while my Facebook feed was being flooded by parents posting pictures of their children in costume, I was at work discussing with my friend various tactics for deterring trick or treaters from my front door.  I obviously don’t have children.  And the doorbell scares my cat.  And I don’t appreciate begging, extortion and gluttony, which is basically what trick or treating is.  But I do love a good costume.

So our discussion turned to costumes and the various guises we had inhabited on Halloween throughout our childhoods.  Many of mine had dark and morbid undertones with lots of fake blood and fangs and black fabric.  One year I had a momentary lapse when my mother sewed a sparkly “good witch” costume.  My friend (who is 6’1″ and about 250lbs) was an Oompa Loompa every year.  Our discussion peaked the interest of one of our plastic/reconstructive surgeons who was dictating nearby.  He said his daughter had wanted to be Voldemort that year.  Not Hermoine, but Voldemort.  I liked her immediately.

Now, I like to entertain the notion that I am impervious to gender stereotypes, but when he proceeded to described in great detail the elaborate robe which he sewed for his daughter’s costume, I was at first skeptical.  Yeah right…you sewed your daughter’s entire costume.  Snort.  But then he showed us pictures on his phone.  And it was gorgeous.

And then I realized…he sews skin better than Buffalo Bill.  So naturally he can sew an elaborate wizard costume.  Naturally.

Didn’t your mamma ever tell you…

My mom taught me a lot of things. A lot. One of them was that I should keep my fingers out of my nose. Which was hard as a little kid with inquisitive tendencies.   Actually, as an adult with seasonal allergies it’s still a little hard. But usually there’s a tissue involved nowadays.

Sometimes at work I run across patients that I have to assume have been raised by wolves.  It’s really the only logical explanation for some of their behavior.  Take, for example, my most recent foray into the world of pediatrics in the form of an 18 year old boy with a spontaneous lung collapse.  Now, I don’t really care for teenagers.  I do realize that I, in fact, was one in the not too distant past.  But I still don’t like them.  They’re loud, obnoxious, try to attract attention to themselves, rude and I’m afraid one of them is going to accidentally bump into or touch me when I have to walk past them at the mall.

This particular teenager wasn’t too bad though.  Maybe he spent only about 50% of his time with wolves.  Despite his low pain tolerance, poor grammar and propensity to mouth breathe, he was okay.  Now, I see a lot of grody things in my line of work.  None of which particularly bother me.  At all.  I can be up to my wrists in someone’s flesh eating bacterial laden abdominal cavity, pulling out yards of smelly gauze packing all the while chatting about the chicken fricassee I made last night to my nurse aide who’s holding the wound open for me.  Its called compartmentalization, and its my second most used psychological defense mechanism.  Try it sometime.

On this day, however, the teenager ruined my groove.  He did something that almost made me puke my coffee all over the floor.  I happened to be standing in the hallway outside his room, doing some computer charting and I glance in to make sure he’s still breathing with the morphine I just gave him for…wait for it….10/10 pain!!  He looks okay, is watching Judge Judy on TV (he must be an old soul…)  Then I see him reach with his middle finger of his right hand into his right nostril and start searching.  I’m standing in the middle of the hall, hands still on the keyboard frozen mid keystroke, watching him and thinking to myself, “Middle finger?  Who uses their middle finger?”  Then, almost in slow motion, he removes his middle finger and it slowly descends down his face and makes a pit stop at his lips.  As I’m screaming “Nooooooooooooo!!!” inside my head he proceeds to use his bottom teeth to scrape whatever it is he’s found up there out from under his fingernail.  Once, twice…and then a lip smack and a swallow.  Frozen, I can’t avert my eyes.  They’re stuck.  And I can feel my coffee rising up in my throat.   He does it again.  My eyes start to water.

Finally, as if sent by God Himself, my pager goes off telling me I have a phone call.  Blessed phone call.  I want to gouge my retinas and rinse my eyes in peroxide, but for now I have to take verbal on a patient coming back from Interventional Radiology.

And I’ll never be the same again.  Judge me if you will.  We all have our idiosyncrasies and nose picking and eating just happen to be mine.  Good day to you.