Wednesday, October 19, 2016

Coal Shoveling Nurses

As a young foolish nurse, I was admonished by much older peers on many occasions and in retrospect, deserved it. After a lengthy tongue lashing, the senior nurse would often conclude her bitter diatribe  with the qualification, "I was shoveling coal at this hospital before you were even born." Coal shoveling was a badge of honor for these older nurses and they frequently pulled the "shoveling coal card," especially if a smart alecky young upstart nurse suggested or thought a new way of doing things was superior to the old fashioned ways.

Until the advent of scrub suits as  the  uniform attire for student nurses, coal shoveling nurse heritage dictated a proper nursing student's uniform. All the diploma school uniforms were very similar. A blue or grey colored dress covered with a pristine white apron. Of course the white apron was neatly folded and carefully stored while the nurse worked her magic with the coal shovel.

One of the develpments that really rattled older coal shoveling era  nurses to the core was the introduction of disposable equipment in the late 1960's. Glass, stainlees steel,  latex rubber, and heavy muslin cloth were the benchmark in determining the quality of hospital supplies according to these seasoned old nurses. Anything that was  made of plastic or felt lightweight was immediately suspect and deemed inferior.

One of the pioneering disposables was a clear plastic enema  bucket and tubing to replace the standard heavy duty duty steel  cans with latex tubing and hard black rubber nozzles. At least early attempts at disposable enema equipment mimicked the old one by maintaining the bucket. If the switch had been from metal cans to the bags of today, old school nurses would have been totally lost. Older nurses called the disposable enema equipment "toys" and eschewed using such unimpressive, light weight equipment.

Coal shovelers  had many bags of tricks and one of their favorites was hiding old school nursing supplies and equipment that much younger nurses had determined to be obsolete. (Just in case.)  Old nurses always had a contingency plan.

 Our intermittent Gomco suctions were often mounted on a difficult to access cabinet because the big bottle patially blocked the door. These hard to reach cabinets were often packed with old school enema cans, latex tubing, clamps, and nozzles. It made sense  because Gomcos and enemas were both used on GI cases. "I shoveled coal in this hospital so I can use any enema can I please!"  Old time nurses certainly had a since of entitlement, though it was  well earned.

Older nurses absolutely hated disposable needles and syringes. They had invested labor intensive  resources in learning to properly assemble a glass syringe with matching the correct barrel to the correct syringe. Sharpening needles was an art form and the special needle sharpener tool and it's proper use a source of great pride. If young nurses made pejorative remarks about the foolishness of needle sharpening they were certain to get the coal shoveling lecture delivered in spades by a chorus of oldster nurses. Until the mid 1970's there was often a rotary needle sharpening tool hidden away in a special unused cabinet or ward locker. I have even witnesses old time nurses sharpening disposable needles just to keep in practice. Old habits die hard.

Old nurses were also on constant lookout for ways to reuse disposable equipment. I vividly recall one elderly nursing supervisor suggesting that used "disposable" endotracheal tubes could be repurposed for retention enemas or barium enemas. " The cuff was the perfect lumen to suitably block exit from the colon. "I bet these endo tubes are radio-opaque so the radiologist could verify proper position in the sigmoid colon. I'm bringing this up at our next procedure committee meeting, "  said one old heavily wrinkled supervisor.  Whenever one of these elderly repurposers came across the ONE TIME USE  warning on disposables it just added fuel to the fire and the conclusion was that one time use as an endotracheal tube and one time use as an enema tube was perfectly acceptable. Twice the bang for the buck.

The next occasion one of you whippersnapperns don a complete surgical glove to insert a Foley, take a moment to remember  that you are standing on the shoulders of oldfoolrns like me  that could slide that Foley in place using only 2 (two) sterile fingercots. I never shoveled coal, but I do have a lengthy repertoire of  ancient nursing skill sets.
Tuck those uncovered fingers into a fist and
now grab that Foley between your index finger
and thumb. The hard part was "rolling" into that
first finger cot without touching it.

Saturday, October 15, 2016

White Coat Ceremonies for Nurses

I was shocked when I learned a local nursing school was holding a white coat ceremony to honor their students  entry to actual clinical practice. Excuse me, but nurse's have a historical and rich tradition and it has nothing to do with those microorganism infested white coats that those high and mighty  doctors wear.  Did you ever hear the term "white coat hypertension?"  It's called that for a reason. White coats do not communicate the comfort and  caring image that nurses bring to the bedside, especially for cranky oldsters like myself. Let the MDs keep their filthy  white coats. Nurse's have something a whole lot better that has real traditional and symbolic  meaning.

It's called capping and any diploma school graduate can attest to the emotional and spiritual elements of a candlelit capping ceremony. Yes, I know that nurses no longer wear caps, but that is no excuse for abandoning one of the time honored and sacred of  nursing traditions. Delivery personnel no longer utilize horses, but truck drivers continue the tradition of belonging to the Teamsters Union. Priests conduct Mass in electrified buildings, but continue to use candles.

Just because nurses no longer wear caps, it's not OK to abandon decades of tradition. You do not throw the baby out with the bath water and then like a parasite attach one self to a physicians white coat. It's just plain wrong and a slap in the face to oldfoolish RN's like myself. Capping is the name of the ceremony that marks a nurses advancement to actual bedside practice. It's been like that for many decades. Why monkey with a good thing?
Let's see you whippersnapperSNs come up
with a White Coat Ceremoy card that has
the charm of this 1950's gem that cost the
princely sum of 15 cents!
Recent  history shows that nursing , especially you academic types, likes to "borrow" ideas from other professions and incorporate them into a nursing context. What the devil is "nursing research?"
Nurses should be doing clinical based research like physicians, pharmacists, and other health professionals are doing. We  don't hear of "doctor research" or "pharmacist research." It's called clinical research and it's done for patients. Borrowing ideas and traditions from others, especially those that poorly reflect traditional nursing values  leads us down that rabbit hole of lost identity.

Soon we become utilization review nurses or computer   nurses whose only preoccupation is generating business or saving insurance companies money. What distance have  we put between the nurse and bedside? I don't think this is progress.

I apologize for my uncouth ranting, my arthritis is driving me nuts today. I have a few higher minded posts in mind for the future so please be patient. Thanks for reading my foolishness.

Tuesday, October 11, 2016

Morphology Malarkey

Recently while visiting one of the teaching  hospitals here in Pittsburgh, I overheard a bright young physician claiming, "The MORPHOLOGY  of this EKG tracing is similar to the one before all the trouble started." It's a good thing Dr. Oddo, an international, Chicago neurosurgeon I used to scrub with did not overhear that young doctor muttering about morphology. I made the mistake of using that M-word term in the midst of a  surgery with Dr. Oddo and received a tongue lashing that made a life long impression. That young resident stirred up a distant memory from my ancient nervous system.

A little background. Before Dr. Oddo received his MD, he had acquired a PHD in one of the branches of a biologic science. I think it was zoology, but don't quote me on that. He was snobby, overly particular and a classic anal retentive personality. For some reason, I simply loved working with him and we were actually on friendly terms outside his OR.

When he launched into one of his blowhard lectures about trivial concerns, I always tried to act overly attentive. He could lecture for hours describing the difference between braided and single strand stainless neurosurgical wire. He would then quiz the residents about every minutia regarding the wire. On one occasion,  he tried to trick me up about which form of wire was easiest to handle and I was ready for him. "I prefer the way the overhead lights reflect off the braided wire. It's much easier to see. In order to handle something you have to see it first."  Dr. Oddo emitted one of his Haruumphs when he really didn't know what to say. His bizarre questions were usually met with stone silence. I usually had a stockpile of generic "answers" waiting for him in the back of my mind.

Neurosurgeons like to use tiny little sponges that we used to call "pattys." One day I was preoccupied with counting a new batch of patty sponges with the circulator when Dr. Oddo called out for a dura hook which is the instrument shown in the illustration on the right. I had my eye on the sponge count in progress and out of my less acute peripheral vision, mistakenly handed Dr. Oddo a nerve root retractor. (The instrument on the left.)
Dr. Oddo was not happy with my wrongful instrument passage. "That's a nerve root retractor, Fool, I asked for a dura hook. I think you need a new pair of eyeglasses or a new brain." I was attempting to come up with a good excuse and replied, "Dr. Oddo the morphology of the instruments is very similar."

That response generated WWIII from Dr. Oddo. "In your case, MORPHOLOGY is a word uttered by a dumb person trying to sound smart. Morphology is a term restricted to biologic reference. It has nothing to do with surgical instruments."  I apologized for my ignorant oversight and it was back to business as usual. One thing that I really liked about Dr. Oddo was that after he let off steam with his harsh and sometimes nasty comments you were once again his favorite scrub nurse.

It sure is a good thing that Dr. Oddo was not present to hear the bright, young physician  at that contemporary Pittsburgh hospital refer to EKG morphology. I smiled to myself and knew that 40 years ago the fur would have been flying had Dr. Oddo caught wind of it.

Sunday, October 9, 2016

A Lady of Pleasure, An Anaerobic Culture, and A New Life

Babies can be very expensive. Our obstetrical set fee schedule and the way it was implemented made prenatal, delivery, and post natal care affordable to virtually anyone. Theoretically, the patient paid a fixed  amount of money ranging from 50 dollars to 500 dollars for all the OB services necessary to deliver and care for the baby.  In practice many of the patients paid nothing. A charity hospital really did offer care when needed to just about anyone showing up. What a refreshing situation and such a contrast to health care today. Uh, oh don't get me started on that one!

The clinic was staffed primarily by OB residents and nursing students. A diverse group of medically underseved women attended the clinic. I often questioned why women of limited means were always referred to as "medically underserved." There were many plenty of doctors and nurses in the vicinity so this was really a contrived term. I guess medically underserved sounds better than needy or impoverished.

As student nurses we were responsible for weights, checking vitals and then getting patients settled in one of the exam rooms for a resident to assess. A petite, quiet, very young woman with shockingly blue eyes named Lisa caught my attention as she looked unusually apprehensive. Her stylish dress was a marked contrast to the other prospective mothers in the waiting area. I chatted with her while checking her vitals and without hesitation she revealed that she was a prostitute and this was her third pregnancy. The previous 2 pregnancies had been terminated in the first trimester with the assistance of "her boss" assumed by me to be her pimp.

"I really want this baby" she said with dogged determination. "The father is  a very smart lawyer. I was very busy at that last big  convention a couple of months ago so it must have been fathered by one of those lawyers." Tenaciously she proudly stated, " My girlfriend and I will raise this child and I want this baby to become someone." This lady seemed committed to raising the child. "I never had much of a chance and I want more for my baby."

I helped her up onto the exam table and positioned her stirrups. Dr. Rebondo came in and did one of his comprehensive check ups. At the conclusion of the exam we always obtained an anaerobic culture from the cervix  to check for gonorrhea. The doctor handed off the culture applicators to me and I immediately plunged them into an anaerobic culture bottle to maintain an oxygen free environment. Lisa was watching me with a puzzled look on her face as I fiddled with the culture bottles.

We used to call them trans-grow culture bottles because the bacteria would replicate in the  media while in transit to the lab. These bottles were clear glass and the growth media was a nasty looking brown/green color. To maintain anaerobic conditions the wooden applicators were snapped off at the bottle neck after being submerged in the culture media and the caps tightly closed. The crunch and crack of breaking the wooden applicator always seemed to startle some patients so I usually explained what I was doing.

As I helped Lisa back up from the gyne table she happened to glance off to the side where I was standing. With shock in her voice she asked me, "Did that come out of me?" I quickly deduced she was referring to the  anaerobic culture bottles with their nasty looking brownish culture media. I realize prostitutes have negative self-image problems, but I could not imagine what frame of mind caused her to think the bottles were from her body. She was genuinely worried.

I explained that she was looking at the culture medium and this was not a bodily substance that came from her. Her relief was immense and she thanked me repeatedly for the explanation. She asked how much longer I would be in school and told me she would ask to see me after the baby was born.

One day before senior banding ceremonies there was a note in my mailbox that Lisa was on the post partum  floor and asked to see me. I  eagerly hustled over to the unit only to fimd Lisa cradling a beautiful baby girl. She was glowing with pride and said she was working on a name. Time went by and Lisa faded from my memory.

Many years later I was orienting a new group of student nurses to the OR. I happened to comment that our 2 cysto rooms at the end of the hall had previously served as delivery rooms. Our OB suite with integrated delivery rooms was fairly new.

 A petite, young student nurse that looked very familiar with those crystalline blue eyes remarked, "I was born at this hospital. Is this where I was born?" I affirmed her birth place and just to make conversation asked when  her birthday was. "It was June 3rd."  Something about the date and her familiar appearance immediately clicked, but I still  could not place her.  Memorable moments from nursing school are seared into my consciousness and June 4th was the date of Senior banding which occurred one day after Lisa gave birth. It took me some time to put all this together, but eventually,  I learned something interesting. The young student nurse was Lisa's daughter named Colleen. I hoped that Colleen's birth  had renewed Lisa's life and brought forth a new beginning. She certainly did a fine job of raising her daughter under challenging circumstances.

Wednesday, October 5, 2016

What is a "TRUE" Medical Emergency?

Whatever happened to the time when physician's office phones were answered by a friendly, caring person instead of  today's  ominous recorded voice intoning: "If this is a TRUE medical emergency hang up and dial 911? " I suppose this is a lame-brained attempt to limit liability, but it does raise some interesting questions.

There is so much emotional leakage from the medical office worker making these recordings. Everytime I listen to my gastroenterologist's phone menu, a new negative emotion becomes apparent. I get the stressed, pressured, burned out  feeling backed up with a generalized malaise and lack of concern. I don't think this is what the good doctors want to communicate to their patients, but back to the TRUE medical emergency questions.

What if a no good, lying, sociopathic pharmaceutical company executive crashed their corporate jet and was sprawled out on the tarmac like a pile of road kill?  Is this a "TRUE" emergency even though the victims were not truthful and  filled with falsehoods? I don't know. I guess it's time to call the doctors office again and run through that gauntlet of phone prompts to make a determination. If we do manage to get through to the good doctor, how can we respect his assessment skills or diagnostic acumen if he is too lazy to even find someone to answer the phone?

Although obscured by the abrupt interruption of life, trauma always presents opportunity for redemption and renewal of life even if it is radically different from the pre trauma persona. Hopefully, a taste of suffering will enable the pharma big shot to imagine the suffering of others and the evils of cashing in on the pain and vulnerabilities of others that happen to be less fortunate. (So sorry for my crude editorializing, sometimes I get carried away. Blame it on the aging process.)

What happens if a false medical emergency transitions to a true medical emergency while the listener is occupied with the multiple phone prompt choices?  I tried to answer this for myself by dialing 911 when I was about 6 phone prompts into the menu and all I got was that annoying high pitched screech of electronic mayhem. It was then that I realized that in my shock and illness induced fogginess that I neglected to hang up as the uncaring smart alecky voice instructed. OOPS... my bad.

In the good old days we had a better way of classifying emergency cases. The really TRUE emergencies were called "Ambulance Cases" and even had a dedicated entrance to the hospital that was actually a big garage door with a big sign above that cleverly announced: AMBULANCE CASES.  Yesterday's paramedics were ambulance drivers. There were no trauma bays or fancy electronic gizmos standing by, just a group of doctors and nurses that would do anything to save  a patient's life.

Does that ambulance case need blood? If his type matches mine, we will get a direct transfusion going STAT. Here is my arm and that antecubital vein is ripe for harvesting so stab away with that 16 gauge  needle. I'm glad I could help and no I could care less what insurance carrier the patient has.

The many TRUE emergencies that did survive back in the good old days is truly astounding. Sometimes the caring and dedication of the doctors and nurses worked miracles and no we did not have any of those new-fangled telephone answering systems. Thank God I was a nurse back in the dark ages before TRUE medical emergencies were even thought of.

Friday, September 30, 2016

The One Man Band Concept Comes to the OR

I simply love one man bands. The notion of one person or one object having more than one function is fascinating and has led to things like Swiss Army Knives and the Shop Smith woodworking tool that is a drill press, lathe, router, bench saw and who knows what else all in one. Unfortunately, the operating room is an area of specialization. Each instrument and person has one specialized purpose. It's time for a new paradigm in surgery where doctors, nurses, and instruments take on more than one function. Here are a few possibilities.

Too much perfectly good product (I learned that term from those smart alecky business types that run hospitals today) gets tossed. It seems like we had to set up suction on just about every case and then throw it out regardless of condition. On some minor cases the suction container was empty at the end of the case. It just so happened that these minor cases had the most frequent episodes of nausea upon emergence from the anesthetic. It's tough to work up much of an emesis after being NPO, but I have seen it happen. I think that raw gastric content without food to act as a buffering agent can be even nastier than the usual garden variety of emesis mixed with an assortment of foodstuffs.

Now grab that  empty suction container and proudly present it to your upchucking patient. This trick worked like a charm until the end of my career when some genius designed a closed system suction bottle. Bring back the old school coatainer that you can zip the top off and you have a dual use product. Not exactly the equivalent of a one man band, but at least we are back on the right track.

A nobel prize awaits the inventor of a truly functional combination needle holder/scissors. This device would have marvelous utility and could free up a harried scrub nurse for important things like counting sponges and cleaning bloody instruments rather than assisting with the actual surgery. I can't tell you the number of times I have been happily buffing up  a Babcock  with a 4X4 so it shines like the bumper on a '57 Cadillac, only to be rudely interrupted by the surgeon bellowing: "Fool get down here, I need you to cut suture for me." There are now combination needle drivers (as you whippersnapperns are so fond of calling them) that are capable of cutting suture. The present  design greatly limits their usefulness. The scissors part of the instrument lies inside the needle driver making it necessary for the surgeon to work with essentially 2 instruments of different lengths. Muscle memory is a powerful mistress and if you want  to drive a surgeon totally nuts, supply him with instruments of differing lengths. There is never a happy ending with this type of muscle memory confusing instrument and the end result is an outburst of swearing. Hey, maybe we could repurpose that suction container as a cuss bank.

What we need here is a needle holder with the gripping jaws exactly the same length as the scissors part. I am thinking of something with a dual head design akin to a bicephalic creature with both the scissors cutting element the same length as the needle holder jaws.

An old school hybrid anesthetist / circulating nurse was sometimes called into duty on late day or  emergency call cases when there was a shortage of personnel. I am certain this would not be tolerated in today's regulated health care world with all the electronic monitoring devices behind that ether screen, but with a BP cuff and precordial stethoscope these were much simpler times. Once a case was under way the anesthetist would call the circulator over and ask for coverage while he attended to an induction in another room. Once surgery was underway he would scamper back to the original room. This did not happen often and once a sleepy resident was aroused to cover it was back to business as usual.

I was scrubbed once with a novice circulator who seemed anxious about her newly found role as an anesthetist. The attending anesthesia doc ran out of the room for an emergency, but offered succinct instructions for the newbie anesthetist: "Every time you take a breath squeeze that big black bag."

I know nothing of laproscopic surgery, but this discipline seems fond of multifunction devices. I recall a few years back, Olympus announced the Thunderbeat a  combination ultrasonic tissue cutting tool and bipolar cautery. Maybe something was lost in the English translation, but I would be plenty nervous if someone wanted to insert a device named Thunderbeat near my spleen or pancreas.

It does seem like a good idea and in retrospect, I wonder why someone never came up with a dual purpose Metzenbaum dissecting scissor and bipolar cautery. It could be named the "Smokeysnips." If someone could figure out how to add a smoke evacuator to this instrument it could serve several needs; a cutting device, a cauterizing device, and a smoke evacuator.

Here is another 3 in 1 device. We used our trusty Mayo scissors to snap the metal band off multidose vials so the contents could be poured into color coded medicine cups on the scrub nurse's Mayo stand. Unfortunately this really dulled a good pair of sharps so a dedicated multidose vial remover would have great utility.

Since our ORs were on the 7th floor, the windows lacked screens. Occasionally a Chuck Yeager of the insect world would make his entrance to the OR. We did have flyswatters, but you could never find one when you needed one. Combine a multidose vial opener and a flyswatter with perhaps an Oxygen tank wrench and Presto, a multi function instrument of unprecedented value.

I'm saving the best for last. After a long case the first thing I loved to do was tear off my mask without untying it. That ripping noise of the attachment strings separating from the mask was down right satisfying. Next on the agenda was a quick eyeglass clean up. Blood, prep solution, bone chip residue and unidentified material had an affinity for eyeglasses. If an enterprising mask supplier could add a strip of microfiber to the part of the mask, it could be used to clean eyeglasses post ripping off shenanigans. I really could have used something like that.

Sunday, September 25, 2016

Epinephrine Evils - A Trio of Heathers Straight From Hell

Allright, it's time for some fun and games. I am breaking a promise to myself to abstain from blogging about present day healthcare. I make it a practice to avoid watching the television, but while on one of my frequent MD visits, the fancy newfangled flat screen TV was showing the House Committee  interrogating  Mylan Pharmaceuticals  jet setting CEO Heather Bresch. It was a  fortuitous circumstance that medical care was close by because  she made me physically ill and even the legislators were disgusted and admonished her sickening greed by hiking the price of an Epipen over 500%.

Suddenly as Yogi Berra so aptly stated "It was deja vu all over again." Another Heather and her malicious use of epinephrine popped into my aging brain. Kristin Heather Gilbert was VA nurse serial killer that murdered patients with IV epinephrine. Those with strong stomachs can google her name for the unsavory details.  I figured if I could connect the dots with these Heathers from Hell, I could break my promise to myself about abstaining from current issues. My suspicions were right on, these Hellish Heathers do have some things in common.  My promise to avoid blogging about  personal health issues (don't get me started on that one,) politics and religion still stand

To play this game simply match the "Heather" pictured on the left to her favorite epinephrine delivery device. The correct matchups are revealed at the end of this post. How's that for a sneaky, underhanded trick to encourage your readership?  I better stop hanging around with these Heathers. They really do creep me out.


What does Heather Bresch, the greedy Mylan Pharmaceutical CEO and Kristin Heather Gilbert a VA nurse and serial killer have in common other than their names. The answer: they both used epinephrine for novel and unintended purposes. While Heather Bresch used a dirt cheap drug, epinephrine to get filthy rich, Kristin Heather Gilbert used it to impress her boyfriend with her cardiac resuscitation skills. Unfortunately the cardiac arrests were caused by Nurse Gilbert overdosing her patients with epinephrine. Two very twisted ladies using a "life saving" drug to fulfill their own personal goals without any consideration of what they were doing to vulnerable patients. Neither one of these Heathers  ever apologized for their actions.

 In 1989 Nurse Gilbert joined the staff of The North Hampton MA Veterans Affairs Hospital. In 1990 she was even featured in a VA publication, The Practitioner. Likewise, Heather Bresch was recognized in Esquire magazine as a 2011 "Patriot of the Year." It's a sad world when it's considered patriotic to accumulate wealth at the expense of vulnerable patients that require medications. Both of these ladies were apparently considered exemplary examples of humankind according to the articles published.
The parallels of these two women are truly stunning. Nurse Gilbert was frequently described as a habitual liar for most of her twisted life. She falsely claimed to be related to Lizzie Borden, the infamous axe killer.  Heather Bresch falsely  claimed she obtained a MBA from West Virginia University  and officials at this school falsified transcripts to reflect classes she never attended. The lies and falsification resulted in the resignation of the university leader, but Ms. Bresch was promoted at Mylan. I imagine that pulling off this academic deception empowered her and set her on her current trajectory of promoting the Epipen and the subsequent crazy price inflation of her product.

Ms. Gilbert had a lover that worked at the same VA hospital on the security force and hospital policy mandated his presence at all cardiac resuscitations. He quickly became impressed with Nurse Gilbert's cardiac arrest skills. In the mid 1990s investigation revealed that the arrests were caused by iatrogenic injection of epinephrine administered by Mrs. Gilbert. At trial in 2001,  it was suggested her motive was to impress the boyfriend. She was convicted of 4 of the murders and is serving a life sentence in a Texas Federal prison. It was speculated that she was responsible for 80 - 100 murders, but this could be much higher as 300+ patients died while under her watch.

Ms Bresch's motives were far less lethal, but I am certain she was on a crusade to impress share holders and boost Mylan stock price. Both of these Heathers turned a blind eye to the vulnerable patients impacted by their nefarious actions to impress a third party that should have been completely out of the picture.

Both of these women had the ability to compartmentalize their lives. Nurse Gilbert had been married and had 2 children which gave outward appearances of normalcy. Ms. Bresch's father Senator Manchin said his daughter was a very kind person and would give anything to someone in need. I guess he was  never underinsured and try to purchase an Epipen for an allergic child.

Both these ladies misled people and put their needs above others. I guess the serial killer, Kristin Heather is the worst part of this very bad lot. When I think of innocent and vulnerable children being deprived of an important medical treatment, it makes me wonder. One thing is for sure, they both would have been publicly shamed in front of their classmates and given the boot from a diploma nursing school. Our behavior was very closely monitored and one false move and you were history.

According to our student handbook, we were never allowed to be in the dorm while possessing money with the exception of a small amount of change for the pay phone. The school emphasized that it provided everything we could ever need including: housing, uniforms, linens, books, lab supplies and 3 meals per day if you could arouse yourself for the 6AM breakfast. Although we did miss out on Heather Bresch's millions, we had every thing we needed to learn nursing and that was all that really mattered.

Overall, stories like these evil Heathers add fuel to an underlying felling of depression. When I was a youngster the best way to avoid dark moods was to immerse myself in the work of the OR. It was tough to feel bad after a long case that went perfectly with Dr. Slambow extolling my virtues and saying with gratitude that he could have never done it without me.  Those bright OR lights boosted a dreary mood . Now as  an oldster, it gives me a sense of pride and peaceful satisfaction to look down at my Bovie burned finger and arthritic knees knowing that I helped someone at their most vulnerable and critical time and never gave a thought to the $4.95 per hour that I earned. You can verify that with some of my old paystubs (Just search Fools Gold- It's Payday.)

 I doubt any of the above Heathers will ever find such peace. I suspect it is fun to jetset about on private aircraft or live in a fancy neighborhood, but when you are old, the good feelings come from memories of people you have helped along the way such as the trauma patient you worked on all night  in the OR and then watched him walk out of the hospital to his waiting  family. I'm not all  that religious, but I am certain there is a special place in Hell for people that use sick, vulnerable people for personal gain. These Heathers are a tsunami of evil, death, and greed.

I should probably stick with my foolishness and old school nursing stories, but seeing Ms. Bresch  so arrogantly testifying before that congressional committee got my old iron poor blood to boiling. Everything is so different today.

The puzzle at the beginning of the post is very simple. Top photo is Heather Bresch and her grossly inflated Epipen. Middle is Heather Snootphull, a notorious drug fiend that tried to get high by inhaling epinephrine nasal spray. Lastly on the bottom is serial killer Kristin Heather Gilbert and her ampules of epinephrine. I betcha she injected a billion dollars worth of that drug at Mylan's prices.