Student Nurse Uniforms-Rules and Regulations (Circa 1969)

 

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On a recent glance through some old nursing school papers a peculiar document jumped out at me. It was a signed copy of our school's uniform requirements which were aggressively enforced with weekly uniform inspections. Since I'm just going to copy the agreement, this post will have a more cohesive narrative arc than my usual foolish ramblings. I guess it's about time for a clean linear narrative that's more coherent than my dementia fueled posts!

UNIFORM REQUIREMENTS

The uniform of the school of nursing should be worn with dignity, respect. and in strict accordance to the following regulations. The complete uniform is worn only in the buildings of the hospital. If worn with a lab coat, the complete uniform may be worn to and from the mailbox at Wellington and Dayton.  (With no quick stops at the Wellington Ave liquor store.)  Sorry sometimes my foolishness just pops out! 

Students are in complete uniform when they are wearing the following:

1. The blue school dress which may not be shorter than the midpoint of the knee.

2. The white school apron, with it's hemline two inches above the hemline of the dress, it is to be worn in all clinical areas except the operating room, obstetrics, pediatrics, and isolation wards.

3.The white school cap (beginning after capping ceremony,) which is to be clean, Argo starched, and properly folded. Seniors are to wear a 5/8 wide black velvet band. The band is placed parallel to the very last row of stitching. The cut edges are folded under the band at their terminus. the cap is secured by white bobby pins and may never be worn outside the hospital.

4. Hair is to be clean, neat, simply styled and away from the face. No loose strands of hair shall contact the face. Hair must not touch the uniform collar. It may be secured by a barrette if the appliance is totally inconspicuous. Pincurls,curlers, or hair ornaments are never to be worn with the cap.

5.Under clothing must be clean, white and in good repair. foundation garments must be serviceable and inconspicuous. Condition of under garments is subject to verification at uniform inspections. (Hmm...maybe that's why I was always rejected when I volunteered to assist with uniform inspections)

All students in complete uniform must wear white clinic shoes, polished and in good repair. Laces are to be clean and white.

Wear hosiery that is white clean and in good repair.

Hands must be clean, and the nails cut short (the optimal subungual space is 1 mm.) No nail polish including clear may be worn. When going off duty a lotion should be applied to the hands-a dermatitis makes the proper cleansing impossible, thus rendering hands unsafe for duty.

Not wear decorative jewelry (this includes wires or plastic appliances for pierced ears.) Name pins are to be worn on the upper left chest.

Each student must carry accessories to complete the uniform. these include a red and black pen, notebook, a watch with accurate second hand, and a bandage scissors.

The student nurse who is properly attired in her uniform has an air of vigor and a joy for the privilege of caring for others.

As usual, male students got a break when it came to uniform regulations. We wore a white scrub top and white cotton pants. I never attended a uniform inspection!  

Portrait of Oldfoolrn As a Young Man

A few recent emails inquiring about my dearth of recent posts with concerns about my health really warmed the cockles of my arteriosclerotic laden heart. Yep...I've had a few recent issues; bilateral knee replacements with complications, cataracts, and an overwhelming (almost) klebsiella sepsis. I would have never survived as a devout weaver of more foolishness without the caring expertise of so many outstanding whippersnapperns! I was deeply touched by their caring and skill. My nursing world was so far removed from theirs that I cloaked my identity as an Oldfoolrn! I lied and told them I worked in a produce warehouse which was partly true.

So I ventured down to my basement junk pile nursing archives to search for an inspiration to write something. Sometimes not writing is as important as writing, but lo and behold I stumbled across this image of me posing in all my foolhardy grace with my esteemed classmates well over 50 years ago. This was a time when 3 year hospital based nursing education (if you could call it that!) ruled the roost.

These archaic programs promulgated some very bizarre notions and customs where consciousness was outsourced to the will of the school. Diploma nursing schools were bastions of laissesz-faire zeitgeist. It might be foolish to describe a Chicago based nursing school using French and German words, but this terminology fits the culture like a glove.

By way of further and complete obfuscation explanation, we were expected to be totally non-judgmental when caring for patients while being subjected to judgments that were akin to dogmas established by religious fanatics. We were prohibited from ever carrying money to reinforce dependency on the school despite living in a building that had marble clad walls, terrazzo floors, and a chandelier in the auditorium that rivaled the one in the opera house. The generosity of well heeled donors extended only to durable structures not people.

We were expected to exhibit an instinctive kindness even when working all hours of the day and night. Our first clinical rotation was during a hot Chicago summer on a detox medical ward. I will never forget the hodge-podge of smells (paraldehyde, emesis, sweat, and Kayexalate induced stools.) The intrepid instructors believed if a student could survive in this environment, they would be able to limp to completion of the program 3,000 hours and 30 months later. We started with 78 probies and graduated 23 nurses. I think the graduates envied the folks who had the sense to bail out!

It's interesting to note from the class picture that only those with the grim sour puss expressions (self included) managed to graduate. My friend, Rhonda, the smiling, ever pleasant young lady on my right left after 6 weeks to escape the mind numbing, soul shattering world of a vintage Chicago training hospital!

Gastric Freeze-A Cold Hearted Idea

A stomach freezing machine. That eggplant size balloon
in the MDs hand was inserted transesophageally and zero
Degree F. ethyl alcohol circulated via a double lumen catheter.

 Whoever came up with that old medical adage stating if there are 3 or more treatments available for a single ailment, none are effective, was likely talking about duodenal ulcer treatments of the 1960s.Whacky dietary regimens featuring half and half or whole cream as the main ingredient, antacids, and of course tranquilizers because nervous folks suffered from ulcers were medical interventions of the day.

About 15% of ulcer patients had a dismal response to medical treatments and required surgery. The operation of choice was a gastrectomy with or without vagotomy (cutting the nerves that stimulate acid secretion.) This was big time surgery of the day and carried about a 5% mortality rate along with patient dissatisfaction from digestive problems. Every old nurse was acutely aware of the dreaded dumping syndrome where high carbohydrate foods entered the duodenum like greased lightening causing dizziness and occasional fainting.

Intractable medical problems like gastric ulcers often produce nonsense like this textbook edict, "The disease is easy to treat but difficult to cure."  (That classic was from our Brunner's Nursing textbook.) About one in ten Americans harbored an ulcer and the disease favored men. The combination of lots of suffering folks and the medical mind set to do something... anything... for a cure frequently produced disastrous results. Medical breakthroughs touted on newspaper front pages sometimes proceeded to the obituaries as time passed. Certainly, this was readily evident with frozen stomachs and their hemorrhagic complications.

In 1960, a group of surgeons headed by the famous Dr. Wangensteen, inventor of the lifesaving intermittent suction named after him came up with the notion that gastric ulcers could be cured by freezing the stomach.  General hypothermia (lowering the body temperature to 86 degrees F. (or 30 degrees C.) was occasionally used to help patients survive brain or cardiac surgery.  Under general hypothermia, gastric acid secretion was noted to decrease.

oldfoolrn: Wagensteen Suction - Elegantly Simple Without Electricity

Dr. Wangensteen questioned, instead of cooling the whole body, what would transpire if only the stomach was chilled? He took the notion one step further and wondered about not merely cooling the stomach, but actually freezing it. I guess he never thought about what happens to a frostbitten ear; it falls off.

Desperate for an ulcer cure, freezing the stomach seemed worth a try. A balloon shaped like the stomach and a double lumen catheter to circulate freezing cold ethyl alcohol (zero degrees F.) through the balloon was devised. Experimental trials in animal trials commenced. I could never, ever work in an animal lab with dogs whose internal organs were rearranged and fooled around with in the dubious name of science.

One of the bizarre demonstrations of the frozen stomach efficacy was to oxygenate a frog and lower it into the stomach of a live dog. From an untreated stomach the completely digested frog was pulled up 6 hours later. From the frozen dog's stomach the frog would emerge hopping away at a lively pace. Yikes.. and I thought watching my cat vomit mouse parts was disgusting!

The May, 1962 Readers Digest ran an article, (They're Freezing Ulcers to Death,) and thousands of patients began demanding the treatment. Maybe they should have renamed the magazine The Digesters Reader! Sorry, blame that one on my foolishness.

The medical industrial complex quickly responded and stomach freezing machines were manufactured for eager hospitals and physicians despite the reservations of more conservative practitioners. This was not another innocuous pill that could be discontinued in the event of complications, but an anatomical alteration with the potential of real morbidity and mortality.

The gastric freeze did eliminate symptoms for some folks, but the ulcers always returned with virulent ferocity. A few unlucky souls experienced immediate separation of the lining of their stomachs and uncontrolled bleeding which required emergency surgery with sometimes catastrophic loss of life. The gastric freeze treatment lasted about 5 years (1963-1968) before practitioners gave it up. Too many complications with loss of life.

A bona fide cure for most gastric ulcers came about when a 1985 article published by Warren and Marshall in The Journal of Gastroenterology described a bacterial infection by H. Pylori as the cause of ulcers. The good doctors proved their point by infecting themselves with the bacteria. an antibiotic regimen proved to be the bonafide cure for gastric ulcers.

Happy Armed Forces Day!

 To all those amazing folks on active duty and veterans, you are deeply appreciated and there is really no way to thank-you for the sacrifices you make. I think of you folks daily!

On Tenterhooks with Atrial Fibrillation!

 Despite the pledge I made to myself to refrain from personal health related complaints, here I go with more foolishness about my recent hospitalization. The nurse-turned-patient phenomenon can be fertile ground for peculiar insights into the illness experience.

I've had episodes of atrial fibrillation now for about 13 years. They are usually no big deal, but combined with a Klebsiella sepsis, the last one was tough to shake off and required more intensive intervention. I was minding my own foolishness in the ER holding area, awaiting an inpatient bed to avail itself when all of a sudden it felt like there was a kettle drum pounding away in my chest. I was going to say that it felt like an elephant sitting on me, but my wife is right, I tend to exaggerate. The medical resident was close by so I told her that my chest was feeling "funny." I really don't like to disclose that I was a nurse to providers so I understate and use foolish vernacular to illustrate my plight. My nursing experiences are too dated to be relevant today.

She took a quick listen with a fancy electronic doodad festooned stethoscope and shrieked to a nearby nurse to put me on a monitor. The nurse hastily applied the electrodes, gazed at the monitor with that avian eyeball intensity and flipped out, shrieking to get the crash cart. I was doing just fine up to this point, but in all the ensuing drama, I felt panicked-not a good thing when you are in atrial fib.

The arrythmia was promptly converted to normal sinus, but I felt guilty for all the excitement my predicament caused.  I was perusing some of the tips for novice nurses on atrial fib that Kati Kleber RN MSN had on her nurse education site, FRESHRN. One of her suggestions really hit home, "Put on your nurse face when caring for a patient in atrial fibrillation." From a patient's perspective, I offer up a hearty AMEN to that one!

For all you bright whippersnapperns out there take a gander at FRESHRN. I really admire Kati's fine work and it's a wonderful resource..

WHAT...Trauma Surgery Cancelled? It's Time for a Fable

 Every long time nurse is acutely aware that nursing can be a leading cause of "fun" deficit. After so many hours standing behind or in front of your Mayo Stand nothing seems to bring about that good feeling that unabated fun provides. (Maybe it's just my foolishness, but I never could deduce if I was in front of my Mayo Stand or hiding behind it.) It's sorta like that chicken and egg quandary about what came first, but when the surgeon is bellowing, I think it's best to be rearward of your Mayo Stand. Boundaries can be a real asset.

It happened more often than you would think, the on call gods were restless and that blasted phone arouses the lowly scrub nurse from a peaceful midwinter slumber. The frantic voice on the other end of the blower announces, "Hey fool...up and at 'em, there is a hot trauma in the ER headed your way, it's time to hit it!"

I scrambled into our trauma room and hastily set up my Mayo and had my back table loaded for bear with enough pieces of sharpened stainless steel for the grandest surgical event known to mankind, Lansing, Michigan! I meticulously scrubbed up at my lucky porcelain scrub sink and my heart was in overdrive, just like a thoroughbred in the starting gate roaring to go.

Most often, this was the beginning of a long, late night slog involving a gazillion needle holders loaded with aching fingers to patch up shredded hollow viscus organs or lacerated livers. My personal, least favorite patch up job was with damaged kidneys, not only were they tough to access in their retroperitoneal hiding spot but required a significant quantity of little fat balls harvested by the hapless scrub nurse to seal and close severed poles. I once asked Dr. Shambaugh to suture a fist sized fat ball to the exposed glomeruli and be done with it and was promptly rebuked, "It doesn't work that way fool!"

Occasionally, an anesthesia resident would poke his head in the swinging OR door and proclaim with overtones of gloom and doom, "The surgery is cancelled, pack up and go back to sleep, Fool, and don't forget the bottom bunk is mine." Cancellations were a big letdown for me and in the back of my head, I knew someone had just crossed over to the other side without even getting a second chance in the OR. Trauma surgery cancellectomies had all the ingredients for a sad...sad story.

So instead of dwelling on death and depression, I would invent alternative realities to the grim happenings. One of my favorite self-told fables was that the poor soul got lucky and managed to sleep it off. What the heck, it was 4:30 AM and everyone else was sound asleep. Everyone is well aware of the regenerative power of a good snooze, well maybe not for massive blunt trauma or big time gunshot wounds, but the notion of  a trauma victim sleeping it off was as comforting as petting a lap dog.

Surgeons and scrub nurses are procedure oriented and live to do things to folks. The sad truth is that most surgical SNAFUS are errors of commission which contrast qualitatively with errors of our non surgical cohorts errors of omission. Maybe this cancellation saved some poor soul from a surgical mishap or foreign body misadventure. HOORAY...that cancellation was a good thing and saved someone from misery and suffering. 

The other mental slight of hand with cancelled emergency surgeries was the notion of a transfer. The fantasy went like this: although we were the only trauma center on the North side of Chicago, the patient was simply moved to another unit or hospital. A much more soothing slight of mindfulness than envisioning a poor soul resting on a hard slab in the morgue cooler.

Although we are living in the twenty-first century, our emotional responses emanate from a stone age brain. Telling yourself uplifting fables isn't all bad, especially if they allay that sense of paralysis inflicted by a troubled limbic nervous system.

Healthcare Paradoxes

  Wake up! It's time for your sleeping pill.

Go Lytely...This stuff is like a Mount Vesuvius eruption purge in a bottle! Not exactly lightly about anything.

Lifesaving surgery...Red Duke, the famous Texas trauma surgeon, debunked this one many moons ago. "When God punches your ticket, he does so with profound authority, without regard to human intervention." 

Soft code...When the notion that CPR was good for all surfaced, the concept of a muted code emerged: walk, don't run, pediatric compressions for 300 pounders, etc. There really is no such animal as a soft code.

Bathroom privileges... This is a biologic need. Do we have room air privileges for patients to breathe?

Therapeutic milieu... I learned the fallacy of this one early on at Downey VA hospital. A nurse office sitter was orienting me to my psych unit announcing that this was their "therapeutic milieu" as she opened the locked door to the ward. A pool ball sizzled by my head like it had been launched from a mortar and 2 patients were bayonetting each other over in a corner with a cue, while a third was struggling to remove an impaled rack from his head. Therapeutic???  I don't think so.

Normal saline...How normal is an IV solution when it can cause metabolic acidosis and renal function changes?

ILL health...Health is health and there is nothing ill about it.

Pressure ulcer... Nope, if pressure caused ulcers, divers would be one giant bedsore. It's the shear forces that cause decubitus ulcers.

Confined to a wheelchair...As an occasional wheelchair user, this one really grinds my gears. Wheelchairs provide mobility and freedom!