Wednesday, December 28, 2016

Venereal Disease Patient Enlightenment (Old School)

Old, hardened, and down right mean nurses were enough to stimulate the worst in terms of nightmares. Bad dreams that could bestir me from my deepest sleep were close at hand when thoughts of these brutal bats in white arose. They were as tough as they come and capable of smoking an unfiltered cigarette  in two deep puffs. It was an amazing experience watching a cigarette burn down 3/4 inch with a single puff. Their perpetually brown, nicotine  stained fingers always looked like they were involved in a messy code brown. At least one can hope that it was nicotine stains.

 Years of witnessing adverse and unfair outcomes in their patients while working for poverty wages was a catalyst for the formation of a bitter, righteous, and judgmental personality profile. If these tough, white starched gestapo nurses suspected a patient's behavior had a causative component to their health predicament; look out because someone is about to be taught a painful lesson by these old "That'll learn ya" nurses.

The hospital where I trained was a designated facility to treat referrals from the public school system for a variety of infectous diseases. Students that suffered from run of the mill  bacterial infections received very good care unless they had the misfortune to be diagnosed with either syphilis or gonorrhea.  These ailments  were termed venereal diseases before the current terminology of sexually transmitted diseases came about. Venereal disease was loaded with stigma and negative connotations which made it a perfect target for corrective actions at the hands of these painful practitioners with punishment on their agenda.

These old nurses had witnessed the gruesome complications of secondary syphilis with tertiary symptoms such as profound dementia from nervous system involvement.  Infected  students needed to be taught a lesson for their own good. The accepted  treatment for these venereal dieases consisted of a series of painful Bicillin injections administered over a two week course and these old nurses used to get involved in heated arguments over who had the pleasure of inflicting this painful punishment treatment. A stroll through the outpatient waiting room often revealed a trembling youngster curled up in a chair while in the background a couple of nurses would be heard claiming their next victim patient.
Bicillin given with care, is a painful experience. The medication is a thick gooey substance with the consistency of toothpaste that burns like fire when forced into a muscle. These old nurses had ways of making the injection even more memorable painful. As students, we passed through the outpatient area frequently. A common sight was a tearful youngster hobbling from one of  the treatment rooms while vigorously rubbing a wounded rump. The elderly, smirking nurse soon followed twirling the spent glimmering  Bicillin  Tubex  injector like a proud drum major with a baton. We always wondered what was going on here.


On our senior rotation some of these punishment minded ancient  nurses let us in on their  pain inducing trade secrets that were truly bone  chilling. In nursing school we learned tehniques to minimize injection pain, but these old bruisers had quite the opposite in mind for their hapless charges.

The sadistic, aged nurses  said one of the best techniques to enhance injection pain was to inject the viscous Bicillin into a tense muscle by having the victim patient bear weight on the hip being injected. Exposure to cold with open windows in winter enhanced shivering which induced even  more muscle tension. Cold was also an effective agent to make the Bicillin even more thick and irritating.  According to these old nurses, a tense shivering buttock was ripe for injecting with thick ice cold Bicillin. These punishment minded nurses also claimed to have Herculean hand strength that enabled them to inject the thick Bicillin with enough speed to actually tear the   gluteus  muscle. "If you can hear above the crying and screaming, you can actually listen to the muscle tearing," one of them related. Ouch, I envisioned the thick Bicillin acting like the business end of a hemostat being opened while buried in the muscle. That must really smart.
Luckily for the infected students, the Bicillin was made available in prefilled cartridges with a fixed, non-interchangeable 18 guage needle or I am certain these old nurses would be looking for a 16 gauge monster needle. Dulling of the needle did increase pain during skin penetration and this was done by deftly inserting it through the tough rubber on a multi-dose vial a couple of times prior to injection. These punishment minded nurses thought of everything. "If you can see the skin around the needle insertion site retract 1/2 an inch in or so before penetration, you have achieved an appropriate level of needle dullness. This should elicit an audible response from the patient," was the nurses explanation of the procedure.
The ubiquitous isopropyl alcohol foil wrapped pledgets so common today were not available for skin prep  40 years ago. These old nurses were fond of cotton balls soaked to the point of dripping for their prep. Wet alcohol that remains on the skin prior to the injection can be tracked deep into the tissue with the  injection which really stings. Most nurses carefully dry the skin before injecting, but not these punishers that dreamed of alcohol soaked and  quivering buttocks awaiting their painful ministrations.
Nurses were taught to carefully rotate injection sites and make a note of this in the medical record. Punishment nurses followed the same principle as WWII pilots that "bombed on the leader." They carefully administered subsequent injections in the exact same tender site as the previous "leader"  nurse. Recipients of this type of treatment often carried lumps the size of golf balls in their hips from the painful repeated injections.

As a youngster, old nurses could really creep me out. I could see where their mean spiritedness came from but doubt that it benefitted anyone. I guess the most kind way to describe their actions would be to say they were misguided. I sometimes wondered if these aging nurses faced consequences for their self -induced lung cancer from heavy smoking. What's good for the goose is good for the gander.

 I'm thinking about a future post explaining overdose  enlightenment protocols that these punishment minded nurses used.

Wednesday, December 21, 2016

Left to their own devices, just about everything deteriorates into a ridiculous hodge-podge of disorder. Entropy truly rules the world. Scrub nurses love order and nothing bothered me more than a cluttered Mayo stand. I am trying to bring some order to this blog by using labels to establish some crude organization to this blog. I really do appreciate indulgers of my foolishness and appreciate your readership.

Happy Holidays, Happy Hanukkah, Merry Christmas, and may your  sponge counts always be correct as your Babcocks shine brightly in the overhead light!

Friday, December 16, 2016

"Twas the Night Before Surgery"

'Twas the night before surgery when all through the OR
Not a Bovie was smoking, not even a bipolar
The drapes were assembled on the back table with care
In  hopes that Dr. Slambow would soon be there

The patient was all narcotized and snug in his bed
While floor nurses insured that nothing was fed
And his roommate in a cast and him on a snooze
They just settled down like a drunk on cheap booze

When out on the expressway arouse such a crash
Bodies thrown from vehicles became  victims of a bash
Away, away, to the hospital they were hustled in a flash
Patients off to St. Profit's to be stripped of their cash

 Half their blood volume lie on the new fallen snow
Not a great thing for hemodynamic flow
When, what to my wondering eyes should appear,
But a  young paramedic with an 18 gauge  spear

With a little old tourniquet so lively and quick
I new in a moment he  would feel a big 'ol stick
More rapid than a sump pump in a flood
They pushed in more of that red stuff called blood

Now volume expanders! now lactated ringers!
Pump that fluid in 'til we see color in his fingers
Raise that bag to the top of the pole
Pump away..Pump away.. til his vitals roll

And then in a twinkling straight up to the OR
The elevator cliked and claced from floor to floor
Wheel him right up next to the table
Call in the nurses and transfer if able

He was covered in blood from his feet to his face
Better lay out a morgue pack just in case
A sucking chest wound was making such a sound
If we don't tube him really quick he'll be moribund

Tell that elective patient all narcotized in bed
His gall bladder has to wait, we have a trauma instead
The scrub nurse and surgeon are fatigued and half dead
Better wait on that cholecystectomy till the nurse gets a bed


Tuesday, December 13, 2016

Surgisplainin

Old time surgeons were at the top of the hospital food chain, the captain of the ship, and sometimes misguided blowhards with overstuffed egos. Overconfidence combined with a condescending, paternalistic attitude toward patients  added up to surgisplanations which minimized operative risks and the true extent of surgery, overstated benefits and touted the operators surgical superiority. If anyone questioned these surgisplainers their response was "I just explain procedures in the language a patient can understand."  They were elderly and often wore expensive wool suits that smelled of moth balls.  I think these are the surgeons Dr. Slambow had in mind when he pontificated that, "The only surgery that really benefits the patient is repair of traumatic injury."

A semi-demented old coot of a surgisplaining  gynecologist always explained a D&C with the same practiced, scripted, delivery, "I'm just going to do a little bit of Dusting and Cleaning in there." This was delivered in a demeaning and  condescending tone of voice to rightfully frightened ladies from an obese, imposing man. He was a jerk of the highest order and if he had been accurate in describing his operative method it would have sounded like this: "I'm going to visualize your cervix by inserting a weighted speculum that tips the scales about as much as my overhanging pandus, then stabilize your cervix by piercing it with two converging sharp points of a tenaculum. While I yank put traction on the tenaculum, I will ream out dilate your cervix with stainless steel cylindrical devices called dilators that progress in diameter to the size of my stogie  so I can scrape the inside of your uterus with a curette. I learned the finer points of curettage by mimicking my cat pawing like a sabertooth tiger at his scratching post. You don't have anything to worry about.

A foreign body  be it a stray sponge or rogue instrument found in a patient after surgery meant that the scrub nurse and circulator on the case would be immediately fired and the surgeon had to come up with some surgisplanin regarding the need for re-operation. This situation presented itself when I was working in neuro ICU with a patient that had undergone a spinal fusion.   I was so tempted to make a copy of the X-ray report and anonymously mail it to the patient, but never did. If I had it to do over, I think that I would have made that copy. The neurosurgeon's surgispanation; "the X-ray showed us something that was not visible during surgery (yeah..because you did not see it and the nurse could not count to 10) that we need to go back in and correct. When I was a scrub nurse, nothing made me feel worse than re opening a partially healed surgical wound. Incising healing tissue just goes aginst the grain. Things like that are just not supposed to happen. The patient had the sponge removed and did just fine post-op. She walked out of the hospital none the wiser of the errant sponge that was left behind during the initial surgery.

There was an old geezer of a neurosurgeon well past his prime  that always had a clever surgisplanation for his patients. His description of a crainiotomy went like this, "We are going to make a little trap door in your head so we can fix you up as good as new." That's it. Now it's time to sign the consent.

If there was a prize for the most understated surgisplanation this one would win the grand prize. Here is what the truth of the matter amounts to. We are going to shave your head bald and after anesthesia induction you will be  positioned in a very dangerous upright  sitting position where it is possible for ambient air to enter a major vessel and cause serious disability. Then I'm going to cut through your scalp which will bleed like the dickens and you better hope the scrub nurse can load Raney clips lickety split. When we get to that nasty AVM, I will try to remove it from vascular circulation before it bleeds too badly. Then we will close and finally, I will drill holes in your bone flap to wire it back in position, Most patients that have there brain handled like this have serious personality changes but don't worry you have good health insurance.

Thankfully these surgisplainers are extinct. The last time I had a procedure, the surgeon carefully explained all possible complications. It was really hard for anyone to trust old time surgisplainers whether they were patient or nurse. I know they used to creep me out.

Thursday, December 8, 2016

Nursing Joins the Money World

There were some sure fire ways to get the boot from a 3 year Diploma school of nursing back in the late 1960's; stealing drugs, falsifying nursing notes, serial uniform code violations, failure to sign in and out of the dorm, having your room light on after 10PM and perhaps the most heinous was having currency in your possession. The student handbook was very explicit on that last infraction.

Students are not allowed to have sums of money in their room our on their person while in the nursing dorm or hospital. It is permissible to have less than $1.50 in change in the student's possession for use in the dorm telephone or for the 25 cent deposit for the use of the sewing machines. Violators will be referred to the School of Nursing Directors office. This violation may result in a determination that  the student is unacceptable for the practice of professional nursing.

The school did provide for virtually all of the student's needs including  books, housing, uniforms, meals, and bed linens. For recreation there were pool tables in the basement, a sundeck on the roof, and a large lounge complete with heavily patrolled conjugal visiting booths with the admonishment that there must be 2 sets of feet on the floor at all times. The nursing school bus made biweekly trips to the Cook County School of Nursing for dips in their beautiful swimming pool.

I think the rationale for the money restriction was to reinforce that you were totally dependent on the school for all your needs. We somewhat derisively referred to the school as "Mother," but it did meet everyone's basic needs for 3 years. All you had to do was follow the rules. We started out with 78 prospective nurses and 24 of us survived to graduation.

Another reason for the no money rule was to reinforce that you were here to "dedicate yourself to the service of mankind." This mantra was repeated very frequently to the extent it felt like being brainwashed. This was a charity hospital and even the doctors were very careful about conspicuous displays of wealth. Dr. Slambow, my surgeon idol, proudly motored to the hospital in his $2,000
Volkswagen Beetle. If he were around today, the first thing he would do is put all the young MDs of today driving BMWs in their rightful place.

Nursing is a calling that has nothing to do with remuneration. Rewards came in the form of caps, bands for caps, and of course that highly coveted pin. According to administrators, angels in white don't need pension plans or decent pay.  If our instructors ever got wind of the notion that we were practicing nursing for the money you were history.

I was watching videos on YouTube of nurses openly discussing salaries for different nursing positions. This would have been professional suicide back in the 1960's and 70's. The first thing we were told about interviewing was to NEVER ask about salary as that would have been the end of the interview.

I think that young whippersnapperns of today have so many financial burdens that we never dreamed about  such as school loans and grossly overpriced textbooks that they have to be concerned with finances. School loans have made education unaffordable. Nevertheless, when I hear a nurse discussing salary or asking for money on a blog for services it sends shivers down my spine. I was harshly conditioned against this line of thinking in my impressionable  adolescent days. I completely understand it, but it creeps my subconscious mind  out because from my experience when nurses talk or ask for money, very bad things happen and you soon find yourself on the outside looking in.

Don't fret, I could never monetize this foolish blog. Who would I "partner" with?  Perhaps hearing aid battery companies or maybe even denture adhesive, I think Polident works best. OOPs I didn't mean to say that. It must be getting past my bed time. I will never sully the "OldfoolRN" media brand (I learned that term from some of you youngsters) with those annoying adds or self serving "partnerships." I learned my lessons about nursing for money at a very young age and those values have stuck like a thick coat of tincture of benzoin.

Nursing provided me with anything that I really needed. Nothing fancy, but the basics were certainly met............Thanks so much for tolerating my foolishness!



Tuesday, December 6, 2016

A Stethoscope Sellout

A scan of my battle scarred, trusty Tycos stethoscope.
No, I don't have one of those new-fangled telephones
that takes a  picture to post on the computer..






My initial excitement soon subsided after reading a blog post about stethoscopes. An important nursing symbol and vital tool of the trade was reduced to a laundry list of currently available stethoscopes along with their prices listed in USD. Christmas is not the only thing that can be reduced to nothingness by crass commercialization. There is a heck of a lot more to talk about stethoscopes  than the current products available from Chinese sweat shops. No wonder people in some foreign countries hate us. How would you like to sit and polish stethoscope bells for the measly sum of 45 cents per hour?

 My all time favorite stethoscope was a Tycos combination model and I spent many happy hours auscultating with  my eyes glued to the back of the diaphragm housing  that proudly proclaimed "Made in Asheville NC." Gazing  at the proud proclamation of manufacturing location seemed to make heart sounds more distinct, I bet those North Carolinians are nice folks. They certainly produced a mighty fine stethoscope back in the 1960's.

I used to wear my Tycos draped around my neck with the earpieces on the left and the bell on the right and now my stethoscope  has a permanently induced  curve to it just like Princess  Leia's buns. Here is a tip for you whippersnapperns; occasionally  change the direction of dangle  from left to right as your stethoscope hangs atound your neck to avert that nasty permanent curvature  problem.

The tubing on my old Tycos scope had a nice supple, almost slippery feel to it. One night while feverishly hanging units of packed cells, I discovered a new use for  my stethoscope. Each unit of blood was supplied with little stickers that provided the identification number of the unit. All I had to do was place the ID stickers anywhere on the stethoscoupe tubing and it was temporarily stuck there until I had a break in the action and could apply them to the chart. That stethoscope tubing was the medical equivalent of sticky note adhesive - it was the perfect parking spot for any type of sticker which could be removed later for the chart. A present day application for this nifty feature might be if your drug seeking patient claims an allergy to an NSID, just make out the allergy sticker and plaster it to your stethoscope until the moment of truth arrives.

Yesterday's nurses were experts at using whatever was available to meet a patient's needs. One of my class mates was working as a school nurse when a young student collapsed with a tongue swollen so acutely that it occluded the airway. No problem for this Macgiver style nurse as she quickly cut a length of tubing from her handy dandy stethoscope and deftly inserted  the lifesaving tube intranasally to bypass the occluding tongue and establish an airway. To prevent the distal end of the nasal airway stethoscope tube  from advancing too far into the nose, she fashioned a safety pin stop.
The kid was gas exchanging like a marathon runner. At the hospital, the nasal airway was swapped for a naso tracheal tube and after steroids and Benadryl, the youngster lived happily ever after.

There is so much more to stethoscope stories than a listing of their prices.

Thursday, December 1, 2016

An Obituary Translator

Aging opens new doors and inspires new pursuits. Lately, I have found a new interest in  perusing a collection of old obituaries accumulated over the years. Almost all of my coworkers have gone on to their great reward in that green ceramic tiled O.R. temple in the sky. At least for them, the OR is back where it belongs on the highest floor. I never felt comfortable when working in an OR that was located below that traditional top floor locus. Having been raised in a sky God culture maybe I will enjoy that top floor OR suite again in my afterlife having served my time in OB purgatory.

 While perusing my collection of old obituaries, I noticed that some  obituaries contained half-truths and downright lies in a belated attempt to bolster dubious accomplishments of some people that were hard core blowhards with questionable abilities.  It's not wise to speak ill of the deceased, but some of these phony embellishments are in dire need of correction. Without further ado, (don't you just love it when oldsters talk like that?) I present the actual  text from the obit followed by my foolish, but truthful translations. All identifiers have been redacted. (I hope.)

This orthopaedic surgeon was also affliliated with The County Zoo and performed surgery on gorillas and other large primates.
I did not make this one up, but did change the name of the zoo to further blur the surgeon's identity. This surgeon would operate on virtually any carbon based life-form, dead or alive. I was scrubbed on the thoracic surgery side  of a severely traumatized auto accident victim with the above orthopedic surgeon working as a separate team on a complex femoral fracture. The thoracic surgeon declared the patient dead, but we could not get this one track ortho man to cease work on the fractured femur. He was like one of Pavlov's dogs and the conditioned response to set a fracture in man or beast / dead or alive was his signature.

Unfortunately, the one track orthopaedic thought process sometimes has it's head buried in the sand. With a mind that sometimes has it's head up it's own rear end, mindlessness of  other vital medical issues produces a colo-rectal surgical  mentality  that is definitely not patient centered. Enough said!


Dr. Y was known for his compassionate and caring manner with a kind smile or a heartfelt embrace to share with family and friends.
The closest I ever came to a "heartfelt embrace" from this surgeon was the time I dodged  a hemostat flung at me with great velocity and I collided with his slow to duck resident. Maybe that kindly smile was obscured by his mask or only present when he hit pay dirt with his  hemostat missiles ,but I highly doubt it. It was more of a smirky, smart alecy smile.

When asked, "Who are your patients?" This sports medicine orthopod replied, "Anyone who is an athlete, or was an athlete, or anyone that enjoys reading sports oriented periodicals."
This well to do orthopedic  surgeon was into medical marketing before advertising corrupted healthcare. Unlike specialties like gynecology, which limits it's practice to 50% of the population, this doctor took on all comers. I used to marvel at the irony of his office décor which consisted of pictures of  steroid fueled line backers delivering crushing, bone shattering blows to hapless ball carriers.  Gross illustrations of compound fractures in the making. This might have been good for his business, but very bad for his battered patients. His office décor that  promoted and glorified such trauma inducing behavior made me wonder why oncologists did not have cigarette ads on display in their offices to help bolster their patient load.

He was a person with a vision; we are what we are today because of people like Bob who did an outstanding job of laying our foundation. Blah..Blah..Blah
This is from the obit of a bigshot health system CEO or back in the day what we referred to as hospital director. Nurses like me made about $1000 per month while the hospital director received about $1400 per month. He used to show his paycheck to prove he was one of us. Times have certainly changed, I wonder what the ratio of CEO to nurse's pay is today.

One of my secrets to long term survival as a nurse was to avoid any hospital or nursing administrative big shots like the plague. The OR was an ideal place, as administrators never showed up there. I would have rather scrubbed for an 8 hour surgical marathon than attend a 45 minute administrative meeting of any kind. Office sitters  and meetings seem to go hand in hand. Meetings bring out the core elements of their very nature of sitting and jaw-jacking without having the slightest clue of clinical activities.   Time to stop - I'm getting carried away.

When appropriate, he could be tough as steel. He ran a strict, no nonsense operating room and that was the only place he was heard to swear.
The writer of this gem must have had limited exposure to this loudmouth of a  surgical blowhard. He used nasty language just about everywhere. He was certainly no Dr. Slambow who considered it poor form to utter benign expletives like "balderdash" or "phooey." The most common and understandable stimulus for cussing in the OR is unexpected equipment malfunction at a critical stage of surgery such as a stapler not stapling or an aneurysm clip slipping out of position. The doctor mentioned in this obit cussed at anything and anyone. If a nurse was too slow in handing him the tie for his gown it was time to let her have it with both barrels. This was not a pleasant person.

Dr. X was a nationally recognized expert in coronary artery surgery. Those who knew him were stunned when he died of a cardiac arrest - a heart attack-  on July 2, 1989. He was stricken while exercising on a treadmill at his Lake Forrest home.
This cardiovascular surgeon was obsessed with deceasing heart disease risk factors. He was very thin and often counseled patients with a normal BMI of 20 or so to lose weight. When he wasn't in the OR he was engaged in aerobic exercise. This was perhaps the most ironic obituaries I have read. I guess the message here is that you cannot beat genetics or fate when it comes to death.

When a patient's family approached Dr. Slambow with accolades for his life saving abilities as a trauma surgeon he always had the same reply, "I just patched him up. Tonight was not his time to go and I did not really have much to do with that." Jack Kevorkian's patients are probably the only people who are really sure about when the time of death comes. For Old fools like me it's best to live one day at a time and savor the moment. You never know what's down the road.