Saturday, May 11, 2019

Overhead IV Racks Done in by IV Pumps and Controllers

An overhead IV rack in it's safest position-on the ground

Imagine a device that would take advantage of unused vertical space above the patient's bedside and free up congested floor space. Sounds too good to be true?  Well, it was.  In the early 1970s a new fangled device came to our fancy new state of the art ICUs. Designed by architects with decades of office sitting experience, but loathed by nurses at the bedside, the wonderous new creation was overhead  suspended IV hangers.

The ceiling was equipped  with tracks that ran around the periphery of the bed in a semi-circle or as a single diagonal running from the foot to the head. A looped hook with ball bearing wheels roamed the confines of the track. The IV rack  had a pigtail like structure at it's upper most  point  that was carefully threaded through the hook and you were in the  business of IV bottles in the sky.

These clever contraptions utilized a release button that dropped the rack down to working level that just happened to be the height of the average bedside nurse. It was fun and games for all until  a spontaneous release that dropped the loaded rack in a nondeviating  path on the top of a vulnerable cranium below. Talk about Excedrin headache #47, that really smarts. I think overhead IV racks may have been the impetus for semi-private rooms. A nurse was concussed by an overhead IV rack and rather than open another hospital room, an additional bed was wheeled in for the traumatized practitioner.

Another problem with overhead racks was a phenomenon known as "uplifted bottle drift." My recollection of high school physics is a bit fuzzy, but one of the facts of inertia included the notion that once a body is set in motion, it stays in motion. A sudden lateral adjustment of the heavy glass bottles position in the ceiling track sometimes meant the contrivance flew past it's intended stopping point resulting in a most unpleasant crash/bang with light fixtures or anything else in it's path. Twin overhead racks over a single bed were an accident waiting to happen. If both loaded racks collided, a shattered glass shower was inevitable as the bottles self destructed. If you think cleaning up glass IV bottles from the floor is bad, you haven't seen anything, as an occupied bed full of injurious glass shards glass was far worse. A two for one deal of the supremely noxious variety as both nurse and patient were potential laceration victims.

Gravity was a dependable vector to deliver IV fluids, but there were lots of variables when the only controlling mechanism was a roller clamp. This necessitated endless fiddling and adjusting as vascular resistance varied or the fluid level in the bottle dropped. See-sawing IV drip rates were always explained by that ubiquitous "P" word. Positional covered lots of possibilities from the position of the IV catheter to the movement of an extremity.

A revolutionary development appeared in the mid 1970s. Fancy little IVAC machines with glowing electric eyes plastered to the drip chamber began appearing. This clever little apparatus accurately controlled pre-set drip rates. Older nurses thought they would never catch on due to their expense, but to me, they were magic in a box. IVACs and the even more sophisticated pumps that followed required an IV pole for support. IV poles meant the death of overhead IV racks. We did keep a couple of the flying IV racks on the unit because a few of the patients enjoyed posting family photos or inspirational slogans on the overhead racks. It was a genuine boon to patient morale to look up and see a reassuring image and some of the hazards of these racks was mitigated by the absence of heavy bottles.

If you are interested in acquiring an artefact of nursing/hospital history, there are loads of these fickle firmament flying fixtures for sale on EBAY. Just don't forget to duck!

Thursday, May 2, 2019

Custom Made Signage by Nurses

 Hospitals are infested with signage developed by office sitting busy bodies promoting policy, giving direction, or threatening grave consequences for those with the nerve to be non-compliant with their all important edicts. Signs have authority and grab your attention. Who  in the world is going to fool with a red bag tagged with the warning: CHEMO THERAPEUTIC INFECTOUS WASTE? It's enough to scare the daylights out of a Pope.

Bedside nurses  put other's   needs before their own  because they are wired differently at the factory as compared to business minded hospital big shots. Information flows down from the top with a remarkable efficiency, but enlightenment gained in the trenches stays there. Hand made signs posted by harried nurses are an attempt  to break this communication barrier. It's difficult and dangerous to transition a one way street to bidirectional traffic, but that doesn't stop sign maker nurses from trying.

Nurses can be their own worst enemy. In nursing school we had a bulletin board for posting NLN test results that we called the wailing wall. Instructors were also known to publicly humiliate their students by posting signage advertising particularly egregious clinical  blunders. One memorable sign announced with great fanfare that "Gwen had attempted to irrigate her patient's Foley catheter with a TB syringe." That was cringe worthy because the syringe was too small by a factor of 100cc. or more.

Step down units are typically located adjacent to critical care units and the staff members get along about as well as cats and dogs. Step down nurses think ICU nurses are cowboy or girl know-it-alls with overblown egos and are eager to put these hot shots in their rightful place. I noticed a huge poster plastered on the ICU locker room door stating "THIS CAME OUT OF ICU." It was a double heparin locked IV catheter. An ICU nurse was probably doing a gazillion things at once and failed to notice the patients IV was capped with a heparin lock and hep locked the needle previously inserted. I figured out a scheme to convert the sign from an admonishment to amusement by inserting several more needles and hep locking  them in place so there was a series of hep locks about a foot long. A dose of good natured badinage helps improve relations among feuding groups of nurses.

UPMC, the health care behemoth here in Pittsburgh has power. When they acquired Montefiore Hospital which was built into a hillside ala Pennsylvania bank barn style they changed the names of the institution's floors. What nerve!  The hospital was entered from the summit of the hill on a floor called "Main." A, B, and C floors were underground and the floor above main was the first floor. UPMC renamed "C" level as the  first floor and the other units followed in numerical sequence. A series of lengthy, confounding memos and signage flowed from the corporate geniuses at UPMC explaining the new nomenclature. Leave it to a nurse to explain things in simple, straight forward language with her sign explaining, "MAIN HAS MOVED TO 4TH FLOOR AND FIRST FLOOR HAS MOVED TO THE 5TH FLOOR." It may have sounded whacky, but everyone knew what she meant.
Who made this sign? Not me!
Coffee is an essential on any nursing unit and anything impeding it's consumption must be dealt with. Our neuro ICU coffee pot shared electrical outlets with a vending machine and somehow the coffe maker was often unplugged. A nurse attached a sign to the electrical cord running from the coffee maker: "DO NOT UNPLUG-VITAL LIFE SUPPORT EQUIPMENT" Folks honored the official looking sign and we always had hot coffee.

Sunday, April 21, 2019

Paul Obis RN - A Pioneering Nurse Influencer

Every young nurse graduates from training school with high minded dreams to heal the world, but after  a couple of years at the bedside the dream begins to fade as burnout sets in. No matter what you do to get around it, sooner or later, it's going to set in like the darkness of night.  An often times rigid and authoritarian hospital environment quashes outside the box thinking and  innovation. I was fortunate to attend school and work with a nurse that could see beyond the bedside and promote health and wellness on a more global scale. We were good friends even though our paths diverged as I stubbornly clung to bedside nursing and he moved on to a more grand vision.

Paul Obis entered nursing school a year after me. He was a slightly built young man with an engaging personality and shoulder length hair. The hair issue was a big deal in nursing school and addressed frequently at uniform inspections. Hair was thought to be a source of infection and everyone on the nursing staff had to keep their hair off the collar while working in the hospital. Paul opted out of the Brilliantine butch haircut for the  typical men in nursing coiffure and went with a pony tail to keep his locks off the collar. What worked for the girls worked for the guys.

Every student nurse has a shocking epiphany early on in nursing school, for me it was how much patients suffered. For Paul, it  was how terrible hospital food choices were for recovering  patients. In the early 1970s the ideal meal was a huge chunk of meat surrounded by something deep fried. The notion of "healthy food" was decades in the future. When someone heard that artificial ingredients and colors were a big component of their diet, the line of thinking was; those clever scientists are at it again. What will they think of next?

Nutition classes in the early 1970s nursing programs promoted notions that white bread was  just as nutritious as whole grain and the ideal protein source was a big chunk of animal flesh smothered in gravy. Paul was quick to note the malnourishment present in hospital patients as diets of the time did practically nothing to promote recovery. Vascular bypasses of one variety or another were the cutting edge procedures of the era. The sad part of this miraculous new surgery was the temporary nature of the complicated fix. Patients were returning to the hospital a few years down the road with their fancy grafts occluded by the very same atherosclerotic changes that afflicted their native anatomy.

The cholesterol theory relating saturated fats to vascular disease was in it's infancy, but this did not deter  Paul who began researching and promoting vegetarian diets as a boon to good health. Vegetarians were few and far between in the early 1970s and excluding meat from a diet was viewed in a freakish light. There was no internet or social media for folks to connect so Paul started writing a little 4 page newsletter with the proud title of Vegetarian Times.

Distribution was limited to the area around the immediate hospital on Chicago's North Side. By Vegetarian Times Issue No. 3 the newsletter circulated to areas that Paul could reach on his bright green  Schwinn Varsity bike. The VT footprint gradually grew to the point where I let Paul deliver them in my brand new Ford Pinto. Paul christened the little Runabout as  the Vegetarian Times Staff Car. A "LOVE ANIMALS -DON'T EAT THEM"  bumper sticker was proudly displayed which got me bemused looks in the Burger King parking lot. I was a blatant  carnivore and never really adopted the meatless life.

Vegetarian Times evolved into a full scale magazine and by 1990 Paul had a media blockbuster on his hands. He worked from an office in Oak Park with a staff of 25 producing the monthly magazine. When I saw the magazine for sale in the gift shop at the hospital where I worked in Pittsburgh, I came to realize the publication had journeyed full circle back to a hospital.
Yep, That's me endorsing VT. It's a good thing that
scrub nurse thing worked out. I was an awful model!

When we were young nurses it seemed as though time was giving us more and more. I now realize it can take everything away too. Sadly,  Paul died of Lewey Body dementia last June His memorial website of a life well lived is:

Saturday, April 6, 2019

A Vintage Operating Room Table

A classic Amsco O.R. Table. Turn one big wheel for elevation, the other for tilting
the head up or down. Grab the gear shift handles to activate breaks. Shift into first
gear and use the stirrups for gyne and urology procedures.
Old time operating rooms were furnished, not equipped like today's technological marvels. The focal point of just about any OR is the table because that's where the all the action happens. Vintage surgical platforms were crude, but effective pieces of furniture that could function without electricity. No complicated owner's manual  necessary. The adjustment wheels applied torque to gigantic screws that moved the table.

One of the design flaws was locating the position of the exposed screws with their inclined plane below the table.  Accessing the controls of a draped table required a trip down under for the circulating nurse. Circulating nurse was one of those new fangled terms and fools older than me called them "hustle nurses."  I was a frequent volunteer for this duty because I relished the serene environment  under a draped OR table while all that noise and fuss emanated from above.

During my under table sojourns it was all too easy to allow for some foolish daydreaming. Those big shining control wheels looked like they belonged on a yacht and sometimes I  imagined myself at the helm of a pleasure vessel on peaceful  Lake Michigan or driving a race car in the Indy 500.  A break from all the drama above always refreshed.

The exposed screws were also in a vulnerable spot when it came to collecting fluids from above. Blood would clot and dry on the surface of the adjustment screw so that subsequent rotations would produce a colorful rooster tail  of flying red flecks that reminded me of those spinning fireworks shooting sparks. The mini pieces of dried blood flying about would also refract the light from the big overheads creating a miniature light show that was a sight to behold

Surgeons had no direct control of patient positioning and were at the mercy of nursing and anesthesia to adjust the table. Positioning attempts were initiated immediately after the one...two...three... count  transferring the patient from a cart. Kindly surgeons like Dr. Slambow would always help lifting and transferring patients from the cart to table. Non verbal, cold as ice stares awaited less helpful surgeons who soon learned the up side of team work.

There were no specialty OR tables back in the days of one size fits all surgical platforms. Sand bags, rolled towels, airplane belt restraints padded with egg crate, and whatever else we could scrounge together made up our somewhat barbaric positioning armamentarium. (I just love that A...… word because it sounds like I might know what I'm talking about!) When we applied a restraint belt to a conscious patient the party line was always, "Since the table is so very narrow we use this for safety." There was no mention of the fact the belt helped keep them on the table if an abrupt anesthesia emergence occurred giving an alternative meaning to ambulatory surgery.

Thursday, March 28, 2019

Looking Good - Feeling Bad

Back in the late 1960s  cures for serious illness were few and far between. Undaunted by bodies mutilated by serious illness, old school nurses were true artisans when it came to making sick, debilitated  patients look good. That old adage, You can't make a silk purse out of a sow's stomach, did not apply to these embellishment minded nurses. Cachexia never looked so gorgeous.

Every bedside nurse was a master when it came to the quick shave. A wash cloth heated in the blanket warmer served to mollify the most robust beard. A few deft strokes with a prep razor produced a dapper looking patient despite the paroxysms of sustained DTs of an alcoholic in the process of sobering up.

Shaving had one well known complication. Intubated patients always had  that pesky pilot balloon dangling in the razor's path and slicing into that tiny little bubble resulted in lots of excitement. A massive leak around the deflated cuff of the endotracheal  called for a STAT reintubation, but, at least, the patient looked nice if you could overlook the terrified expression elicited by a crash intubation..

Another trick in the looking good procedure manual was fooling  around with the lighting. Jaundiced patients always looked much worse under incandescent illumination, so open the drapes and turn off the overheads in the room. Avoiding yellow bedspreads helps too. Patients with an elevated bilirubin of 4 mg/dl  never looked so good.

Out of sight, out of mind was the philosophy of wound management and the bigger the surgery, the bigger the dressing. Abdominal surgeries incorporated another layer of obfuscation, the scultetus binder. A patient might feel as though their belly lost a battle with a chain saw, but hey, they can't see a thing until that dreaded dressing change.

The importance of accessory items such as eyeglasses and wrist watches in the looking good gambit  is illustrated by the sad tale of a 47 year old man suffering from terminal heart disease. Haskell Karp of Skokie Illinois was the first recipient of an artificial heart. Famed Texas heart surgeon, Dr. Denton Cooley made quick work of the situation and in a 47 minute surgery the artificial heart was in place. The device functioned for 3 days when a transplant became available, but death came 2 days later from operative complications.

It was especially important that a patient  fortunate to receive  doomed by the first totally mechanical heart to look attractive. This was international news and lots of folks were watching. Nurses went all out  to convert what was a terminal event to a flattering photo op. The illustration below shows Haskell fresh off the operating table awaiting the return of consciousness and the delivery of The New York Times. Reading glasses in position for a cursory perusal of the business section. Looking good!

Haskell Karp   Circa 1969

Thursday, March 21, 2019

Nurses of The Greatest Generation

Miss Bruiser, a proud member of The Greatest Generation
My indoctrination , if you could call it that, to the world of nursing  came under the tutelage of a rough and tough assemblage of gallant geezers from the heart of The Greatest Generation. These nurses were forged in a cauldron of  devastating diseases, arrogant paternalistic physicians, and a life of abject poverty where it was a virtue to eschew any accumulation of material goods.

Battle scared nurses like these aroused paradoxical emotions among lowly student nurses. We held them up as the ultimate in role models, yet we wanted to be nothing like them in their surly approach to nursing care and life in general. Their level of dedication was without question, but their demeanor left much to be desired as they were a frightening assemblage of care givers.

These  nurses had sacrificed and paid the price on a daily basis. Trivial pastimes and activities for amusement were unheard of. Today's notion of self care for nurses would have ignited a hearty belly laugh from these nurses and a stern rebuke, "Spend more time with your patients and stop thinking about yourself. It's not about you!!" The notion that caring for others required caring for yourself was the ultimate in tomfoolery.

These nurses were masters at giving up personal comfort for what bordered on self  torture. Sacrificing ease for discomfort to benefit patients was second nature to this intense hard core group. Their footwear, Red Cross shoes, were metatarsal unfriendly to say the least. Remember that Pulitzer Prize photo of the nurse kissing the sailor at the conclusion of WWII?  Those were bunion busting Red Cross Shoes and a podiatrist's nightmare. Those heavy, white starched uniforms looked very official, but on those wards that were brick oven hot, cotton clothing acted like a sweatsuit. I don't know how they functioned with pools of sweat dripping from overheated extremities.

Vintage diploma nursing schools were ruled by a set of rigid authoritarian regulations. Marriage was prohibited any time during those tortuous 3 years and pregnancy meant an automatic expulsion. One of my fellow students had a fascinating tale about her mother's determination to graduate from nurse's training. Mary's Mom was a large-scale sized person so a few extra pounds on her was like an extra suitcase on a Boeing 747; not something noticeable. Near the end of the nursing program she became pregnant with Mary. She delivered the baby at nearby Ravenswood Hospital a couple of weeks prior to graduation and was present for the final awarding of her nursing pin with not a soul the wiser. Mary was in the graduation audience cradled in her grandmother's arms.

Nurses from this era had a sense of consecratedness to their profession where persistence was one of the primary themes. These folks had a never say die mindset and persistent nurses never quit when it gets rough, when they lose, or when it hurts. I've known older nurses to continue working despite disabling arthritis and physical disability that would hobble just about anyone else.

Older nurses were highly skeptical of anything new. I remember the outcry over the installation of  nurse call lights when wards were being divided to semi-private rooms. These nurses thought it was ridiculous for a patient to summon a nurse by pressing a button. The nurse should always be close to the bedside. Team nursing, disposable needles, anything made of plastic,  and  swadged, atraumatic sutures were other useless new fangled ideas. Why tinker with something that worked for decades.

It's a good thing that Press Ganey patient surveys were unheard of  in this era. Old nurses were in charge and always  knew what was best for their patients. Any health problem that could be construed as self-inflicted drew a particularly tough, unsympathetic rebuke. As a student caring for an alcoholic patient with draining wounds on his legs, I was enlightened by one of the older nurses, "That's all the filth and evil leaving his body," Rita knowingly advised. I was belittled when coming to the patient's defense. Clearly, these nurses were not ones to tolerate dissent.

Friday, March 15, 2019

Fun in The Sun at Diploma Nursing Schools

"After I sink this one, let's  visit the sun deck!"
Old time 3 year diploma nursing schools lacked the recreational amenities  of modern learning institutions, but they did provide some outlets for brow beaten,  harried students to unwind. The notion of fresh air and sunshine as a curative modality was a core value of the traditional Nightengale mindset; hospitals had solariums and almost every nursing school had a sundeck.

As sundecks were the common denominator at diploma nursing schools, most hospitals had at least one other diversional activity. Cook County School of Nursing had a magnificent indoor swimming pool. After a brief journey through dingy, rat infested catacombs an elegant facility complete with Romanesque columns emerged. The lavish pool was a  unique oasis oddly situated in the midst of a dingy, depressing, medically underserved environment of intractable social problems and abject poverty. A true diamond in the rough.

 Our hospital had a lowly pool table located adjacent to the sun deck entrance and students often picked up a cue and attacked the racked balls before sunning themselves. Nearby Ravenswood hospital had dual purpose sundeck that also served as a badminton court. Weiss Memorial Hospital had a combo shuffleboard court sundeck.

Most all sundecks in Chicago hospital nursing schools  were located on the roof of the nursing school as a concession to the cramped urban environment. The nurse's sundeck was on the roof and 4 stories off the ground at our beloved learning institution. (If you could even call it that.) The operating rooms on the seventh floor overlooked the nurse's residence sun deck and provided geezer surgeons an unobtrusive vector for ogling the scantily clad students. An amorous break from the rigors of the operating room was only three stories away and many took advantage of the opportunity.

A generous sized cedar wooden deck that occupied about a third of the roof top made up the formal deck. This structure was surrounded by a chain link fence that prominently commanded a sense of forbiddance. A few deck chairs and a large phony looking  plasticized   palm tree provided atmosphere. A tropical paradise amongst the Chicago concrete jungle seemed to be the idea.  Just toss a dime in the nearby beverage  vending machine for a can of Tab soda and stretch out on a beach chaise. Life was good.
Tropical Bliss Comes to a Chicago Nursing School
Sundeck activities, like everything else, were governed by the rules set forth in every student nurse's bible, the official student hand book. Here is what the powers at be had to say:
A sundeck is provided for the convenience and pleasure of the students. It is open from 8AM to sunset. School linens, pillows and blankets are not to be taken out on the sundeck. Radios are permitted on the sun porch if played softly. Suitable chairs, chaise lounges, and mats are provided and must be returned after each use. Some type of beach coat or covering must be worn to and from the sundeck.

Like Baptists, diploma nursing schools firmly believed in total immersion, not in water, but in the hospital milieu.  I think any oppressed minority cultivates  a latent rebellious streak and student nurses were no exception. The sundeck overlooked the faculty entrance to the hallowed halls of the lecture auditorium where bitter, hardened, old instructors put their students through their paces. After a severe ear beating on the clinical unit for a pillow oriented the wrong way  toward the door, one of the students, Rose, hatched a diabolical plot for revenge. An Asepto syringe and a bath basin created a sluice of water that cascaded over the sundeck just as the formidable Miss Bruiser made an appearance. She was an aficionado of flowing capes, but nevertheless received a generous soaking

Soon after Miss Bruiser's unfortunate encounter with the cascading fountain of water, a warning sign was posted; Any  student caught propelling any substance off the sun deck will be referred to the student disciplinary committee for possible expulsion. As young Rose loaded her Asepto for another aquatic volley she replied with a snicker, "They have to catch us first!"