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.

“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.

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.

Put down the chicken strip…

If you had a paper cut, would you ask for a slice of lemon to rub on it?

If you had just burned your mouth on scalding pizza cheese, would you quickly grab a swig of hot coffee?

If you had a fresh blister from a new pair of heels, would you put them back on right after it popped and exposed the raw skin?

If your butt smells like something crawled up there and died, would you fart on an elevator?

No?

Then why would you order chicken strips right after you’ve just asked me for a dose of phenergan to take away your ‘nausea’?

Oh yeah…because you’re not really nauseated. And because phenergan makes you feel good. And I must look like I graduated from nursing school this morning before shift change.

Bypass

If you’ve had a gastric bypass, lost just enough weight to warrant a panniculectomy and are post-opping on my floor, what the frick are you doing eating biscuits & gravy, bacon and pepsi for breakfast!?!?  Skin stretches you know, and that 18 grand you just spent will soon be in the toilet….like your breakfast after you get a nice painful, crampy bout with dumping syndrome.