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!

Sunday, May 22, 2022

Name This Mystery Equipment

 


I just love hospital mysteries, so I was delighted when a nurse emailed me these photos of a vintage device found in the ER at a Catholic Hospital, St. Vincents, in Cleveland, Ohio. The folks there were unable to identify it and it didn't ring any bells with me so I was thinking (a rare event for me) that maybe someone from my vast readership could lend a clue.

My first guess was that this was some sort of contraption from the hospital laundry. After sheets were dumped from a gigantic steaming cauldron, they were run through rollers to squeeze off excess water. Those rollers were a serious entanglement hazard for the poor folks toiling in this hell with the lid off environment. I had a special place in my heart for the Hispanic crew that worked the hospital laundry. I would practice my lackluster Spanish with these friendly folks and marvel at how happy they were in such an oppressive environment. I had life easy compared to their hardships!

My next speculative theory involved the radiology department. Before the advent of automated film processors where raw exposed film was inserted in one end and a finished X-ray slid out the back, roller film processors were used to conserve developer and fixer. The exposed X-ray film was loaded into the roller processors in a darkroom and chemicals introduced by a light proof port. The drum rolled which sloshed the entire film with chemical. You did not need any signage to find the radiology department, just follow the pungent smell of fixer with your proboscis!

My next brainstorm (more likely a brain fart) was this was a dispenser for the giant rolls of paper used to cover exam tables. Handling these giant rolls of paper always reminded me of octopus wrestling-get one end secured and the other end would pop up.

I did contact Oldfoolette. a central supply queen, from the dark ages and she could not identify it as any medical device. So perhaps the notion of this being a piece of hospital equipment was a cognitive disruption entity. We did have some whacky things in our ER that came in with patients and stayed behind in the ER.

We had a Chicago CTA turnstile from the Ravenswood El station that ensnared a fare jumpers lower extremities as he tried to vault over it and save 35 cents. Chicago's finest brought him in turnstile and all. I have a previous post about a poor soul who froze to death in a Chicago Park District garbage can. We kept the can and every time I read that HELP KEEP CHICAGO CLEAN slogan my heart skipped a beat. We kept the tunstile and trash can. Don't ask me why.

Any guesses about the identity of the above object would be most welcome!   

Saturday, April 23, 2022

Selling Tenormin

 

What's that old Madison Avenue advertising axiom? If I remember correctly, it's "sell the sizzle not the steak." Sure, every nurse is aware of drug reps acting as poseurs for selling pharmaceuticals with their usual give aways of pens, stationary, and assorted bunk, but when Tenormin went off patent the good folks at Astra Zeneca went bananas with marketing ploys in an attempt to keep the big bucks coming for their name brand gold mine. Tenormin was consistently in the top 20 most frequently prescribed drugs and no doubt brought in gazzilions of dollars which brought smiles to stockholders while cash strapped seniors wolfed down their only affordable meal, Alpo suppers. I knew that trouble was brewing when I learned Alpo only made canine specific meals!

An entire culture was invented to persuade physicians to prescribe the brand name Tenormin in lieu of dirt cheap generic  atenolol. Drum roll please...Wellspring was an entire civilization with Tenormin at the apex, invented by clever marketing gurus. There was even a Wellspring magazine with healthy lifestyle tips centered around consumption of this pricey beta blocker. I perused one issue and I was struck by the well tanned healthy youngsters frolicking around a beach. Not a single geezer  with a tremulous manner and spreading jowls!

The give aways promoting Tenormin were top notch, not your usual cheap pen and stationary give away.  Astra Zeneca was well aware that lots of drug company swag found it's way to the circular file, but who in the world would toss a pair of priceless  collectible coins?  Most physicians were not numismatists and were not aware that the wheat penny featured in the Tenormin collectible coin set was valued at 30 cents and the nickel was likely not worth much more than 5 cents. The fancy encased (I was going to say entombed, but came to my senses,) coin set likely displayed in a prominent place on the good MDs desk as a constant reminder to prescribe Tenormin.

For nurses there was the lovely Wellspring wrist watch complete with a lovely red heart smack in the middle of the dial. Internet websites for advertising were far in the future, but Astra Zeneca had a WATS telephone line number (800-937-4027) where you could listen to a prerecorded message touting the benefits of Tenormin. A sweet sounding starlet rambled on and on how Tenormin did not induce depression, so common with other Beta blockers, because it did not cross the blood/brain barrier. Heck, I used to ring her up late at night just to stay awake. There was something about that melodic voice that kept me going. Dr. Slambow was aware of my tricks and when my scrub nurse skills were hampered by fatigue, he would say, "Fool it's time to call that Tenormin lady!"

Nursing crises of one sort or another could really shiver your timbers and leave you feel like you were walking a high wire with only cunning and a parasol with the chasm  chanting it's siren call way down below. Leave it to Wellspring to come up with a unique antidote for these forlorn times. When the real sh*tstorms rained down on the hapless practitioner. They sprung a genuine Wellspring umbrella as a freebe. My Wellspring parasol lasted all of a couple of hours. While strolling back to my apartment after a late night in the OR, a classic Chicago wind blast destroyed my Wellspring give away. They don't call Chicago the windy city for nothing.

There was something about this tour de force of  pharmaceutical marketing that shook me in some ways I wasn't even able to name. Wellspring just seemed wrong. Most nurses had a less than favorable view of drug sales folks and likened them to vultures, but I had a different avian vision of these proud hucksters of pharmaceutical wonder drugs. I envisioned drug reps as having all the charms of an old country goose: ordinary with a pleasant demeanor, but an irascible beast that will peck your eyes out when it came down to the hard sell.