Tuesday, May 26, 2015

The Quotable Keith (also, weather update)

We are fine here in Littleton. Bigton has hellish flooding, as do Houston and Dallas, but we in the sticks are far enough uphill of everything that we're not getting washed away. Thanks to everybody for the good wishes; I have purchased a teeny canoe for the cats and have outfitted the dog in a diving suit with one of those round windows in the helmet.

And now, what you've all been waiting for. . . .

Keith, CNRN, PCCN, CSRN, CCRN: "Why would a patient with Hashimoto's encephalopathy be on a neurological unit, rather than on med-surg, seen by endocrinology?"



Keith, CNRN, PCCN, CSRN, CCRN: "I've never understood why myesthenia gravis patients and people with Guillain-Barre came to a pulmonary unit."


Keith, Expert On Weather: "What we need is about five more feet of rain. Then we won't be in a drought for, like, years."


Keith, Arbiter of All Things Religious: "Josh Duggar was just curious. It's not like touching his sisters was molesting them."


Keith, Man of Men and Understander of Wimminfolk: "What women need is a good home and family. It's why feminists are always so angry."

Thank you. Thank you all. Good night.

Saturday, May 23, 2015

Lists.

Things I need to do this week:

1. Buy floaties
2. Figure out some way of keeping my trash bins from being washed down the street
3. Review alternate routes to work in case Lake Littleton overflows the ancient two-lane bridge that spans it
4. Grow gills and webbed feet

The rain hasn't been as bad here as it has been in North Texas, but Jeez. Everything Deep In The Heart of Texas is soaked.


Things I need to do to deal with Keith:

1. Answer patiently when he asks me why a patient with Hashimoto's encephalopathy is on a neuro unit rather than under the endocrine service
2. Ignore his assertions that Josh Groban is Classical Music
3. Not correct him when he gets the timeline of inspiration backwards vis a vis Vivaldi and Bach
4. Figure out where to hide his body at work, and
5. How to dispose of it without getting DNA all over my car


Things I need to do around the house:

1. Weed the front beds, if it ever stops raining
2. Buy a dehumidifier
3. Re-up flood insurance
4. Prep three sets of scrubs for this coming week
5. Brush Mongo
6. Groceries


Things I need to cook:

1. Omelettes for the coming week (my preferred breakfast; usually involves mushrooms)
2. Chef salad, pasta, that fantastic quinoa salad my neighbor fed me, White Girl Bibimbop (aka MmmBop)
3. Something for dinner each night
4. That goes with cheap white wine


Phone calls I need to make:

1. Mammogram
2. Dentist
3. Vet
4. Mom
5. Lotion Slut Sister Pens
6. Dial-a-Prayer

Tuesday, May 19, 2015

Adventures in Keithland, part I

We have one rule at Sunnydale that is unbreakable. It has to do with scheduling, and it goes like this: everybody, no matter how long they've been with the crew or what their lives are like, has to work weekends once in a while. The official rule is that every person works one Friday, one Saturday, and one Sunday, with an additional Friday or Saturday thrown in, every schedule. The schedules cover eight weeks, so this is not an onerous requirement. Most folks get it over with by working one F/S/S run and then picking up an extra weekend shift as they please.

Except for Keith, who has filled out every tentative schedule from now until Christmas and has not put himself down on any Sunday on any of them. We chatted about that the other day.

"Well," Keith said, after I had pointed out the problem, "I suppose I could try to work a Sunday, since y'all have been so accomodating of my school schedule."

I replied, more patiently than I felt, that he should not try, but do, because it is the one rule that we have. The One Fucking Rule, for God's sake.

Keith said that he likes to go to church on Sundays. Said it makes him feel all "rejuvenated."

Now, even in Bigton, the liberal enclave of Texas, folk like to get their religion on now and then. However, the One Rule applies to everybody. Doesn't matter if you're a Jew who needs Friday off prior to sundown. Doesn't matter if you're Muslim or Hindu or a devout Cafeterian:  you work what you agreed to, or you drop back to part-time or leave.

Also, there are two other people on the staff who are devout churchgoers. Even if I and every other person on staff worked every Sunday from now until Judgement Day, we would probably not cover all our bases every week. Plus, that's unfair.

Plus, Keith, this is what you signed up for. Vadge up.

Because, honestly, if you really want to feel rejuvenated in a Christlike fashion, I could nail you to a cross.

So anyway, I sent out an email about it as soon as we'd finished our discussion, because ain't nobody got time for involving the manager in something like a schedule problem.

Keith then regaled me with tales of the first earthquake he'd ever felt, and don't ask me how he got started on that, and how it was a magnitude 7 in some place like Singapore or Central Iowa. I said, mildly, that I hadn't heard of Singapore being damaged by a magnitude 7 earthquake, nor Des Moines, and wondered aloud if he knew what a logarithmic scale actually meant.

I did not use the term "fucking idiot" at any point and for that I should get a medal.




Monday, May 18, 2015

It happened again.

After the Day of the Seizing patient, Kitty and Courtney and I took three days off. We met again, yesterday, when a patient's family member (not the same patient, not the same family member) caught her shoe on a perfectly flat place on the floor and fell.

I saw her fall. She didn't even have the chance to get her hands out in front of her. She landed with a horrible smacking noise, right on her face. And so we hit the panic button and who should come around the corner but Courtney.

Who helped us check the person out, helped us help her up, got her back into the room she came from (she refused to go to the ED), and then stood and stared at us. With a "REALLY??" expression on her face.

What she said really doesn't bear repeating. I guess, when you have a father who spent time in the Navy, you learn lots of interesting turns of phrase.

And that was my day yesterday.

Today I worked with Keith, and came up with some interesting turns of phrase of my own. But now is not the time for those stories. Now is the time for a pizza and wine and bed.

Friday, May 15, 2015

Well. That was hairy.

It was a normal day in the CCU at Sunnydale (Hospital for the Hellmouth). Admissions, discharges, multiple procedures requiring conscious sedation, doctors getting all fumble-fingered with the new order templates, the bathrooms out of order.

It was normal until Courtney showed up. Court stands barely five feet tall, might weigh a hundred pounds soaking wet, and is the finest nurse I know. She's worked in every critical-care area there is, from trauma to burns to places where twelve drips on one patient are the norm, and once crawled into a crushed car--while seven months pregnant and on a flight crew--to retrieve the unconscious victim of an MVA. She is the bomb.

Normal became fantastic when she stopped by. She had the role of emergency responder that day, carrying her bag with all her magical devices in it. When somebody goes bad, instead of calling a code (that is, if they're still breathing), you call the emergency response person. And when it's Court, you know you're getting a quality response. Plus, she's funny as hell.

So I was glad she was there when the family member of one of my stroke patients stepped out into the hall, grabbed his head, and then passed out in his sister's arms. Sister lowered him to the ground, screaming for help, and Courtney and I were there before he'd hit the ground. I turned him on his side, Court hit the panic button that would call everybody to help, and Kitty got the crash cart.

And then he started to seize. Ever tried to start a line in a six-five man with crap veins while he's in the middle of a tonic-clonic seizure? I don't recommend it as a fun way to start your weekend. I couldn't get anything, so I handed him off to Courtney, who found a vein in his arm that I had tried for and missed. Kit was setting up suction and popping a nonrebreather on him at that point, and I was trying to keep his head from slamming into the wall any more than it had already.

At that point respiratory showed up. And pharmacy, and the internal med PA, and every damn nurse on the planet. Courtney was busy taking care of our now-patient, so I was the one who got to direct things: You, call 911 and get us an ambulance. You, call the ED at Holy Kamole and give 'em the heads-up on this dude. You and you, get the vitals the machine is rattling off every minute. You, stand by with your bougie and tubes. Who's recording, even though this isn't an official code? Nobody? Okay, you do that. You, go get a gurney and a lift board so we can get this dude off the floor. Where's Ginny the Inappropriate Chaplain? You, page her. Get her up here.

All done slick as snot, with no raised voices, no panic, no missed steps. He seized four times in five minutes. We gave him Ativan in an attempt to stop the seizures, and he ate it up. It took 5 milligrams of the stuff (for nonmedical types, that's two-and-a-half to five times what it normally takes) to get him quieted down.

Then the EMS guys showed up. I love paramedics. They started two more lines in a literal minute, started fluids, got the guy's airway protected, and wheeled him off.

And, after we all took a deep collective breath, Courtney sat down in the station and said, "Okay, y'all. That went well, but what could we have improved?" and we had a debriefing session.

It was the smoothest emergency response I've ever seen. I'm really proud of all of us. Nobody's hair caught fire, nobody panicked, nobody was just standing around with nothing to do. The people who had tasks did them, while the people who weren't tasked with something melted away to go take care of their own things. It was fucking model.

And it happened at 1805, and all of us got our charting done and got out on time.

I work with good people.

Saturday, May 09, 2015

Dear Cheerful Nurse from the ED at County General. . . .

Thanks for calling. Thanks for being so cheerful! I don't know how you do it, working, as you do, in the pits of hell.

I apologize for that patient who stumbled into your ED today. He stumbled into ours, here at Sunnydale, with a chief complaint of having fallen over due to weakness on his left side. When the CT and MRI didn't show anything, the folks in our ED transferred him to the Neuro CCU. . .but not before he started demanding pain medication for his stroke pain.

Because strokes, as you know, are painful.

(end scarcasm)

Anyway, I got him up here and determined that, while he did show some weakness on the left side, it was distractable. Sometimes it moved to the right side. Sometimes he complained of tingling and numbness all over. At least, that's what I think he said; it was hard to tell, given how many teeth he was missing. Yes, yes, he told me he wasn't a heroin addict too. I'm sure he wasn't; after all, if a person's a heroin addict, that means they'll have tracks all over and crappy veins, and it only took two tries with a Sono-Site to find a vein in his upper arm, so that's not so bad, right? Right?

Oh, you saw those healing puncture wounds, too? Well, I'm sure we can agree they weren't from heroin. Of course not.

Gosh, you sure are cheerful.

Yeah, he told me that he was heading over to County, since the folks over there knew how to treat him. After all, because he's not a heroin addict, there's no reason he shouldn't get Dilaudid or methadone for his stroke pain. He repeated that a number of times to both me and the doctor, who said he was messing with the wrong sheriff. Given the doctor's age, accent, personality, and ethnicity, all I could think of at that point was Cleavon Little in "Blazing Saddles," and I'm certain I made a spectacle of myself, going red-faced in an attempt not to bust out laughing. Luckily, the doctor had seen "Blazing Saddles" too, and caught my eye, and said, "'Scuze me while I WHIP THIS OUT" before pulling the records that had come up from the ED with the patient.

I do love my colleagues.

But not nearly as much as I love you, Cheerful Nurse from the ED at County General. You're indefagitable.

Where were we? Sorry. Oh, yes, the track marks. That didn't come from shooting up any and every imaginable substance while not living on the streets. Yes, we saw those. You'll notice, if you look at the guy's feet and under his tongue, more of them. No, I did not look at his penis. Sorry. My exam was truncated.

My exam was truncated by his starting to swing at me, demanding AMA paperwork, and generally being a cussing asshole. I was fine with him swinging at me while I was standing at the foot of the bed, but once I moved in to try to take out his IV, the swinging got a lot closer and a hell of a lot more personal. Which explains why he showed up at CGED with an IV from Sunnydale still in his upper arm. Consider it a favor from me to you; you don't have to risk sticking him. Y'know, he tried to stab the above-mentioned Doctor Sheriff with a shiv made from a spoon when Doc Sheriff asked him a few simple questions, I'm sure you'll agree that leaving the IV in was the best choice. Discretion is, after all, the better part of not contracting blood-borne diseases.

That was why I had Danny wheel him out after he signed out AMA. Danny is six-five, three-fifty, Polynesian, and covered with interesting geometric tattoos. Somewhere, there's a photo of me curled up under the desk in the fetal position as a result of that patient interaction. I can send it to you if you're interested. That's really all I can tell you. No, no, you don't have to send him back, you can keep this one.

Thanks. 'Bye, now. Byeeee.


Thursday, April 30, 2015

Hey, I just met you, and this is crazy,

. . .but I have the sudden urge to smack you over and over and over with a shovel across the back of the head, so could you sit down?

Thanks.

I am like Grumpy Cat: my life is empty without someone to hate.

After a rough period in December, when it seemed every nurse in Texas had disappeared without leaving so much as a shoelace behind, things are good in the CCU. We're staffed well. There's Kitty, who has sold her soul to the Devil in exchange for the ability to do a razor-sharp wing with liquid eyeliner *every* *time*. There's Marcie, who is good and beautiful and brilliant and so sweet I dread having to tell her that there is no Easter Bunny. And she's been a nurse for ten years, too, so this is not something that's going away. There's the night crew, who refer to themselves collectively as Team Awesome, and who are not overstating things. And there's Keith.

Keith (not his real name; if they pick me up for murder, they can't prove it) is the smartest nurse ever. He already has a master's under his belt at the age of 30, he's working on his DNP in adult acute care? Or critical care? Or something? He knows every policy and procedure in the manual. HIPAA is an open book. He can, he assured me on day one, run a code by himself. He is a fucking genius. He has been a nurse for five years.

He does not know how to set up a suction rig. He does not know what angioedema looks like. He does not understand how swallowing works, and that silent aspiration is a thing. He does not, in fact, know how to run a code at all, let alone by himself.

Now, I'm willing to excuse all of that and more in a new nurse. Contrary to how I might sound on here, I am the preceptor you want. I'll entertain any question without making you feel like a moron, because even supposedly stupid questions usually have logical backing. I'll show you cool shit and get you into the transplant OR and pull strings so you, too, can hold a heart as it beats outside somebody's body. You can practice IVs on me.

However. If you're a supposedly experienced nurse, who's worked four places in five years (wtf is up with that it's not like the economy has been great why did that not trigger anybody's warning bells oh my GOD), and you make a critical medication error, giving five times the dose of an opiate to an opiate-naive patient, and then turn your back on them in order to futz with the computer, and *then* try to blame the error on *me,* I will cut you.

If you try to pin something on Marcie that she did not do, then boy, your life as you know it just got a whole lot worse.



Keith's head and me, May 2015

Can I get an A-men.

For the time being, we have appealed to Wonderful Boss as a group, and Keith is going down to the bowels of Holy Kamole in order to train with Betty in Interventional Radiology. Betty is sixty. Betty is a dedicated Crossfitter and member of a motorcycle club. Betty runs a six-minute mile, faster than she did when she was an Army nurse. Betty is two years away from retirement and takes even less shit than she used to.

Keith will know, if he knows nothing else, how to dose people for conscious sedation. And what to do if he fucks up. And he'll know exactly why it's a bad idea to try to bully the people he works with.

I feel alive again. I feel like I'm no longer wasting my time, if there's an ego to destroy and dreams to crush.

Or maybe that's the double-bacon cheeseburger I ate for lunch talking.