Tuesday, February 14, 2023

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..

Wednesday, January 11, 2023

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.

Friday, November 4, 2022

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!

Saturday, October 29, 2022

Fun With Artificial Intelligence Image Generators


Since my native intelligence has been flumoxed by brain numbing complications from my knee replacement surgery, I've turned to artificial intelligence image generators for some foolish amusement. I typed in Old fool RN on "Stable Diffuusion," an open source image generator and my prompts produced this appropriate image. Maybe I should replace that rather dated blog profile photo of me standing under the overhead lights in the OR. Hmmm...I love how that under the overheads lingo sounds. It doesn't take much to amuse a fool.

If you have an opportunity check out Stable Diffusion. It's easier than a camera or paint brushes to construct images. Hopefully artists and photographers won't be data based out of an occupation, but who knows?

Sunday, October 23, 2022

Institutional Misogynism: The Women of Downey VA Hospital

At the height of the Viet Nam War, Buddhist Monks doused themselves with gasoline and immolated themselves near U.S. facilities to protest America's involvement in the conflict. Two Army nurses rushed to the aid of a monk who set himself ablaze near a remote Army field hospital. A Viet Cong sniper fired on one nurse, killing her instantly. The second nurse, for obscure reasons, was ignored by the sniper and survived. Screaming hysterically and subsequently lapsing into a mute state, the sole survivor eventually found her way to a long-term ward at Downey VA Hospital, a warehouse for the mentally ill. The slain nurse was hailed as a heroine and awarded several posthumous medals and an honorary promotion to Major. A street at Fort Sheridan Army Base was named after her.

(A snippet of Downey V.A. Hospital folklore)

I  worked as a nurse at Downey V.A. Hospital for several months before I was aware there were women veterans confined amidst the 1600+ men. One evening I received a frantic phone call from a nurse in Building 135 asking if I could come to their ward and start an IV on a patient who was seizing. My recent medical background was an anomaly among Downey nurses. Most nurses employed there had worked on the back wards for decades, allowing their med-surg skills to atrophy. Eager to be accepted in this strange new land, I let it be known if there was an emergent medical problem, I was available to do what I could.

I furiously jammed my bit key into the worn slot on the heavy solid steel door on ward 3A, Building 135 and the portal opened briefly and ominously clicked shut. I was shocked to see an emaciated young lady seizing away on the dayroom floor. I should have suspected that any women patients at Downey VA were sequestered in gender segregated silos. At the time, womens' roles in the military were restricted by gender. It was a male dominated world with tentacles that extended to the V.A. psych wards.

I learned there were two locked female wards at Downey in Building 135 and they were the only ones available in the entire health system. Everyone here was seriously mentally ill and a danger to themselves or others. This arrangement concentrated the most acute patients in one facility while separating them from family and community resources. 

The wards at Downey VA were touted for their therapeutic  milieu, but it's a real strain to deduce what could be gained by such profound isolation. There was an on-ward dining room where meals were served to avoid comingling with the young bucks in the communal chow hall. Washers and dryers were also available to reinforce that matronly obligation of wash day duties. The place was a tour de force of isolation  and womanly perspicacity.

Surfacing from my IV start and a hastily administered bolus of Valium, it was readily apparent that the wards in building 135 were much newer than my native Building 66 which was constructed in the 1920s. These contemporary quarters were straight out of the aseptic construction of medical surgical units. The gleaming terrazo floors and ceramic tile walls were more appropriate to an operating room than a place of comfortable lodging and recovery.

I had the notion that psychiatric units ought to be constructed in the architecture of theaters; not operating rooms. There was no shortage of high drama at Downey V.A.  In lieu of a stage, the television assumed the focal point  with the viewers numbly looking on like a brace of zombies. The TV came on at seven AM and droned on until bedtime.

I heard rumors that pregnant women gave birth on the unit and indeed there was an exam room eqipped with a table that sprouted stirrups from it's distal end. Hopefully mothers were carefully screened to delineate complicated deliveries, but you can never assume when it comes to VA care. The facility was loathe to having patients treated in community hospitals and had medical surgical units on site so the men did not have to venture off base for care. Pregnant patients flayed by desperate life circumstances giving birth on a psychiatric unit made me wonder what chance the infant had for a normal life.

As I eyeballed and wondered what a lone mattress was doing  on the dayroom floor, an attendant enlightened me. "We do takedowns differently here. I know you guys over in Building 66 like to countdown and have everyone grab an extremity to apply full leather restraints, but here we just force the unruly patient into a corner using the mattress as a shield and hold them there until they calm down. Visions of a mattress held vertically and used to pin down a patient reminded me of the Chicago Police in their riot gear and shields at the 1968 Democratic Convention riots.

Walking back to the hallowed halls of building 66 I thought of a cat driven high in a tree by a pack of dogs. Safe at last, but completely isolated like the women in Building 135. Maybe it's time to call the fire department.

Thursday, October 20, 2022

Yep...I'm Still Vertical, Part 2

 I encountered a tsunami of post-op complications following my total knee replacement surgery in August, but am starting to feel a return to my foolish baseline.  I received a fascinating email from Anna Pivoras, Executive Director of the Boone County Museum of History in Belvidere, Ill that got me back to thinking about this much neglected blog.

Anna read my posts about Downey VA Hospital because she has an amazing collection of journals from a woman who was a patient at this facility. Janet L. was a college graduate who played the organ for several churches and was very ambitious and active in her community. She joined the Army from 1942-1945 and taught kindergarten after leaving the service. She gave the appearance of being highly functional as she was engaged, had a nice car, and apartment.

After the death of her parents Janet decompensated and was sent to Downey for 3 months in 1967, where "they just wore her out." She became physically ill and was treated and sent back to her ward while still suffering from bouts of nausea. Unfortunately, this was fairly common at Downey. One of my saddest memories is of an elderly man suffering from psychosis as a result of an extended period of time on cardiopulmnary bypass placed in with young psychotic Viet Nam veterans.

The journals from 1971-1974 document a sad and troubled life with paranoid ideation, She chain smokes, a habit of just about every Downey patient because "GI" cigarettes were free and if you had funds, sold for 27 cents in the canteen. She has constant nightmares about shots, needles, hospitals, and psychiatrists. 

This sad story awakened my memory of the 2 womens' wards at Downey VA Hospital which were pretty much isolated from the rest of the facility. As soon as I can organize my thoughts, (HA...HA) not an easy task in my shape, I hope to get a post together on this forlorn topic.

Sunday, July 24, 2022

Yep...I'm Still Vertical!

 I've received several emails recently from folks concerned about my health as a result of the dearth of posts on Oldfoolrn.blogspot.com. It's heart warming to think that you care enough to shoot me an email. When I started this blog, I made myself two promises. no politics and no belly aching about personal health issues.

I made the mistake of posting one topic that could be construed as political and learned my lesson; no more politics. My immobility problems have worsened as a result of a combination of osteoarthritis and Crohns disease induced poly-arthropathy. Thankfully the intestinal Crohns nonsense has been quiet lately. In 2009 I had both intestinal symptoms and multiple joint arthropathy, not a good combination when you have to double time it to the bathroom! 

Anyhow, I'm finally having a left total knee replacement on August 3rd so I can hobble about my little hovel.  I've been occupied with lots of pre-op testing and clearances from a plethora of medicos and everything seems to be all set!

Meanwhile, I hope some of you can enjoy some of my old posts. The 2 all time most read posts are "Not On My Backtable" and the one on that dreaded operating room nemesis, perineal fallout. You can be sure the first thing I'm going to check out when I'm wheeled into that OR is that rubber bands are in place around the distal portion of everyones' scrub suits. I'm also having this done under spinal anesthesia so I can keep an eye on the goings on!