Monday, January 13, 2020

Were You Ever Afraid of Contracting Somthing From a Patient?

  I was almost infected with greed fever
Someone on Quora asked me if I was ever afraid of  contracting something from a patient and a plague of answers began swirling around  in what's left of my ancient cognitive vault. Hmm...was it Hepatitis C, influenza, or step throat? Well, no, something else suddenly came to mind and it did not involve a bacterium or virus. It was pure unadulterated greed. Something all too ubiquitous in today's healthcare world and as contagious as the most virulent virus.

As a novice nurse one of my patients was confined to a self imposed isolation in a private room on one of the nicer hospital units. He had a high forehead with bushy eyebrows and  a prominent jaw line that did not betray a hint of weakness or doubt. He had a definite presence about himself.  His name was Ray Kroc and the McDonalds restaurant empire was his brainchild. Billions and billions of burgers meant big bucks and a lifestyle ordinary folks could only dream about.

 The reason for his hospitalization was weight loss. One too many BigMacs had taken a toll on his waistline and rather than purchase a bigger belt he checked into the hospital for a carefully supervised dietary regimen. Rich people do strange things and a  huge monetary donation reserved his hospital bed. Money can buy anything.

He was very friendly and interested in the workings of a big city hospital. After hearing a few of my tales about hospital experiences he came up with a grand  proposition for me. His business sense told him there was a pent up demand for male nurses and not all that many nurses carried XY chromosomes. According to him, a nursing agency for male nurses could be quite lucrative with careful marketing.

I looked down at my lowly Timex watch and compared it to the gleaming Rolex on his fat wrist. Hmm, I thought, maybe I could swap my Raleigh Super Course bicycle for a motor vehicle. I was just about to contract a very bad case of greed as dollar signs danced in my head.

Then I came to my senses. Greed suppression was an integral component of nursing education. Nurses weren't supposed to have much of anything. The ANA code of ethics even prohibited RNs from endorsing any commercial products. All the nurse influencers of today would be in big trouble as money making was definitely not in the cards for a nurse. Nurses were supposed to be selfless caregivers often at their own expense.

I began to think of all the experiences I would miss if I were worried about my balance sheet instead of the names on a Kardex. Being well off financially disconnects you from the day to day activities  that define the experience of everyday folks. I would have missed out on the warmth and caring shown to me by a homeless person in the ER  when he taught me how to keep warm in a Chicago winter by wrapping layers of newspaper around my extremities. I hoped I would never need the skill, but the kindly way it was explained to me stayed with me. I can still see his warm smile.

When nurses leave a  patient's room after a failed code they seldom look back. Somehow I managed to corral my greed impulse and never looked back. An agency for male nurses sounded like a dubious proposition and, besides,  I always thought of myself just as a plain old nurse. No gender qualification needed.

Thursday, January 2, 2020

Nursing School Probies Had a Rough Initiation

Right this way to the swimming pool!
First year hospital   diploma nursing students were affectionately referred to as "probies" which was short hand for probationer. Probies had a rough life and were at the mercy of junior and senior nursing students for their first 6 weeks. Some of the more benign pranks inflicted on the  hapless probies were scavenger hunts to central supply for things like fallopian tubes or enema nozzles and  getting doused with water blasted from an asepto syringe.

Some of the initiation shenanigans were a bit shocking and proved to me that estrogen could be just as potent as testosterone when it came to fueling hijinks aimed at demeaning innocent victims. Groups of hospital hardened young women possessed a mystical herd strength fueled by their clinical nursing experiences and were eager to share the misery with novices. Somehow, the girls who were the most faint-hearted became the most aggressive tormentors.

 Nursing was emotionally and physically challenging and the initiation was designed to weed out the more faint of heart. Steel plating was a prerequisite for the rigors of vintage hospital nursing.

Many hospital nursing schools in Chicago  had beautiful indoor swimming pools. Cook County Hospital had one of the fanciest which  resembled a Roman bath complete with marble columns. What a contrast to the stark Nightengale wards packed to the gills with suffering, impoverished patients. Luxury in the midst of poverty always rankled my hackles.

Unbeknownst to probies, our hospital lacked a swimming pool but did have an old fashioned exterior  fire escape tube connected to the second floor freshman dormitory on one end and the great outdoors on the other. In the event of a fire, the fleeing victims opened the double doors to the tube and flung themselves into the awaiting platform that quickly transitioned into a steep descent. Gravity did the rest as the victim flew through the tortuous tube at breakneck velocity landing, hopefully, safely on the outside.

Junior and senior students knew how to grease the skids, so to speak, by applying pilfered bone wax to the inclined tube's interior with ABD dressing pads. This made the descent even more terrifying, especially to the unexpecting probies.

The probie trap was baited by covering the EMERGENCY FIRE EXIT sign on the escape tube's entrance with an ordinary sheet and substituting it with a sign clearly stating: SWIMMING POOL OPEN. The deception was further enhanced by soaking a washcloth with Clorox and tossing it just inside the opening to the tortuous tube. The tortuous tube even smelled like a swimming pool.

"O.K. probbies it's time for a group swim," was the battle cry as the doors to the cleverly disguised fire escape were gleefully swung open. As the probies made their sudden descent a satisfying ( at least to the juniors and senior students,) cacophony of shrieks and screams emerged from the tortuous tubes. Any probbie further back in the line up was advised the screams were in good fun and initiatd by the cold water in the pool.

Sunday, December 22, 2019

Merry Christmas

Merry Christmas to all. I can identify with that Christmas tree shown above because although I'm worn out and a bit scraggly, I'm still vertical. I spent a good number of holidays working in the hospital and like my colleagues above always found something to be joyful about even in the most dire of circumstances. There is always a silver lining, especially at Christmas.

Before my brain freeze set in, I came up with this a few years back. My readership was no where near what it is now, so if you need a chuckle, here's the link:    https://oldfoolrn.blogspot.com/search?q=twas+the+night

Thursday, December 5, 2019

Nursing Diploma Schools Were Providers With a Price

Diploma schools provided "free" textbooks
It was the crack of dawn on the very first day of a new class and we were seated at our hard wooden chair/desk hybrids. Those  old hardwood seating devices had a writing surface that resembled a bent canoe paddle that followed a serpentine course until it was right in front of you. This clever design averted a hasty exit because you had to swing out laterally before standing up. Scanty student seats like this were scorned by those unfortunate enough to be left-handed as there was no upper extremity support while writing.

Miss Bruiser, my favorite instructor was doing her gestapo waltz around the classroom depositing a brand new text book smack dab in the middle of the business end of the canoe paddle desk. We all knew what was coming next and dutifully treated our new books as if they were a hot branding iron. Like all "gifts" from the school, books came with a harsh admonishment. Everything from uniforms to housing had a price and I'm not referring to dollar signs.

"Before you students put your grubby little lunch hooks on these brand new textbooks, I have a little paper for you to read and sign," Miss Bruiser bellowed as she dolded out the pungent scented mimeographed documents. We were conditioned just like Pavlov's dogs to the scent of mimeograph ink. That unique smell spelled trouble in the form of a test, written admonishment, or stern warning from a rigid authoritarian instructor or senior nurse.

Here is what the nursing school party line was on handling our sacred nursing textbooks. Hold the book  with it's back resting on the surface of your desk; let the front cover down, then the other, holding the leaves in one hand while you open a few leaves at the back, then a few at the front, and so on, alternately opening back and front, gently pressing open the sections until you reach the center of the book. Do this several times for the best result. Open the volume violently or carelessly in any one place and you will break the back and cause a start in the leaves. Never, ever force the back of a book.

I let loose with a muted chuckle before endorsing the mimeographed missive and paid a heavy price; I had to "volunteer" as a patient while the sophomores practiced their phlebotomy skills on my prominent veins.




Wednesday, November 27, 2019

Giving Thanks

I need to scribble  something  here to obliterate that image of a transorbital intubation in the previous post.  Jeez...that image gives me the willys. What was I thinking?  It's no wonder I got blacklisted by a couple of referral sites for being too grotesque. Blame it on poor judgment instilled by far too many years in the trenches. What comes to me, I suppose, not every time, but often enough, are the inelegant vignettes of trauma that have pitched a tent in my hippocampus.

So it's time to move on.  I'm wishing a festive Thanksgiving to all those who peruse my foolishness. I'm humbled by your readership and it simply  amazes me that someone is always viewing my foolishness-especially those who visit the middle of the night when all should be sound asleep.

I have so much to be thankful for, especially the patients I cared for in days gone past. They did more for me than I did for them. One thought that never escaped me was the notion that all those nasty ailments lurking out there in the world are equal opportunity afflictors. Anyone could be stricken down any time. It's really just a matter of chance accompanied by good fortune that I was fortunate to remain healthy and  vertical for so long.

Glioblastomas are out there in the world  and occur at the rate of about 4 per 100,000 people. I owe so much to those patients that suffered and ultimately succumbed to this terrible neoplasm. It could have just as likely been me with the glioma, but someone else took  all that pain and suffering to spare me of this terrible fate. I owe them a deep debt because it could have me.  I don't know how many times I uttered a silent thank you to these patients and tried to do something special for them. I am eternally grateful to these patients who took the hit for me.

This gratitude fills me with a sense of helpful sharing and a strong disdain for the greed and financial preoccupation of healthcare today. Oops... don't get me started on that one! The respect and peace that nursing has filled my soul with cannot be  derailed by dollar signs. It's what's left in your heart when the day is done that really matter, not your bank account.

Anyhow, for some genuine foolishness here is a link to a post I wrote some time ago https://oldfoolrn.blogspot.com/2015/11/how-do-you-cook-thanksgiving-turkey-in.html

Happy Thanksgiving! I treasure your loyal readership. It  means more to me  than you know!

Tuesday, November 19, 2019

Transorbital Intubation - An Artful Airway

Just when I thought the days of art in medicine were extinct,  the above image made it's appearance in my email courtesy of a long time reader. This  patient had extensive facial surgery for an invasive tumor and her maxilla and eye were sacrificed in the process. In a subsequent procedure, the creative anesthetist used this artsy approach in securing her airway. Instead of passing the endotracheal tube pharynx-larynx-trachea, the path was eye socket - pharynx, (or what's left of it) - trachea. Very clever, but how in blue blazes can the pilot balloon be visualized when it's deep inside the patient's face. Art in surgery always has a down side

Whippersnapperns live in a data driven, evidence based world of healthcare, but I know of  a different world where art played a dominant role  like the transorbital airway gambit shown above. Medical arts buildings dotted the landscape and old school surgeons pulled the art card to explain complications or pathology beyond their understanding. I do think the "medical arts" terminology when applied to physician offices  was so much less pretentious than the "institute" label trending today.

Unlike the group practices of today, most vintage surgeons were solo practitioners operating with minimal oversight. These surgeons of bygone years shared something in common with Picasso and Monet, they worked alone and relied on their ingenuity as much as scientific principle. "Based on empirical reasoning, I'm going to take out this lymph node over here and maybe the one over there too," was a typical intraoperative response.

Artful surgery could carry a heavy price for the patient. Someone cobbled together a procedure to "cure" Parkinson's Disease that involved harvesting cells from the difficult to access adrenal glands and injecting  them intracranially in hopes they would generate some much needed dopamine. The aggressive surgery resulted in lots of complications with poor long term results. Artful, but dangerous and usually ineffective.

A more benign example of surgical artistry involved the use of surgical instruments. Orthopedic surgeons found a novel use for Satinsky vascular clamps in that they were perfect for nabbing errant bone chips. I've written about the creative use for grooved directors in a previous post. They make great tongue depressors, templates for duct filets, guiding suture, and as mini retractors. Artistry in surgery always has an unsavory component and burying the sharp prongs of a towel clip in an unsuspecting abdomen to test the level of spinal anesthesia always shivered my timbers.

Unfortunately, patient's bodies make for a poor canvas and scalpel wielding surgical artists often come up with an unintended surprise on their hands. I wonder how that patient above felt about breathing through her eye socket. Breathing is a whole lot different than seeing.

Tuesday, October 29, 2019

Fine Dining Hospital Nursing School Style

Oh..The tales that were told during mandatory dinner hour.
Vintage  hospital diploma schools were hybrid affairs: one part workhouse, one part charm school, and one part plantation. The charm school component made attendance mandatory  for the evening meal in the hospital cafeteria if you happened to be fortunate enough to work  on a clinical unit during the 3-11:30 shift. Sharing a meal together was probably  thought to have a positive  social impact on  hospital confined and culturally deprived nursing students

The nursing school had commandeered a long table in the very back of the chow hall. A sense of decorum was added to the ho hum environment by the use of genuine china dinner plates emblazoned with "IMMC School of Nursing  Dedicated to the Service of Mankind."  Another unique touch was the  disbursement of several bottles of Red Hot Sauce prominently displayed as a centerpiece.

Nursing students were undernourished in social experiences and overfed on shame and degradation  dished out by mean old coots masquerading as instructors. The fine china and special sauce adornment was a lame attempt to mitigate the harsh realities of life as a nursing student and spice things up a bit.

Working with the most challenging patients was difficult enough, but our tough minded, anal retentive instructors demanded strict self-regulation of our behavior. There was no crying, complaining, or lamentations of any sort permitted. We always answered to our hard core instructors in plantation speak, "Yes'um, No madame, and Right away," were stock replies.

So when we all sat down together for dinner, it felt as though a weight had been lifted off our shoulders. Typical dinner table conversation revolved around difficult nursing procedures and technical tips for their  successful completion. Occasionally the various foodstuffs were used as props. I will never forget the time my friend, Janess, demonstrated her prowess at removing fecal impactions by using a stale donut leftover from breakfast and an overcooked chunk of bratwurst. The key was to bury your finger well into the brat and the flex the distal phalanx into a hook like device before pulling it  through the donut.

Being the sole male at the dinner table had it's awkward moments when I was called to mediate arguments about boyfriends or menstrual cycles. Although I may have been a disinterested party my knowledge base was not up to snuff and led to lots of round about jibber jabber.

Our final dinner together as student nurses was held outside the hospital at a really nice nearby restaurant, The Ivanhoe, which was just down the street between Clark and Halsted.  The senior dinner held right before we were crowned GNs was memorable because or instructors were finally nice to us because we survived and were on our way to becoming peers. I made up my mind then and there that I was never going to treat anyone as we were treated as students.