Friday, October 30, 2015

Happy Halloween

Hospitals can be fertile ground for spooky, scary stuff. This abandon OR really does look kind of creepy. Just imagine the people that probably had their souls separated from their earthly bodies in this very room. Maybe there is some type of virulent bacteria or pathogen embedded in the ceramic tile grout. What about those ceiling ventilation openings? Most likely  they are still equipped with filthy air filters saturated with all kinds of bad pathogenic  things. It looks like a good place to hold your breath or wear one of those hazmat suits.

There are certainly other scary things associated with hospitals related to blood and gore, but these are too obvious. Subtle little events can creep up on you. As a young scrub nurse, one thing used to really freak me out. It never seemed to bother anyone else so I never vocalized my feelings of being creeped out. I guess I did not want to be thought of as an insecure scrub nurse.

Here is what gave me nightmares. We are nearing the end of a trauma case that was going along smoothly, a walk in the park.  We are getting ready to close and all I have left on my Mayo stand is a couple of needle drivers, scissors  and a pair of pick-ups. The surgeon announces, "I think I would like to get a stat X-Ray just to make sure we removed all of the fragments." In marches the X-ray technician with the portable machine. He wrestles the X-ray plate into position underneath the drapes  and announces "Everybody take cover I'm shooting an X-ray."  The circulating nurse and anesthetist run out of the room and the scrubbed members of the team hustle over into the corner behind a lead curtain.

A horrified glance over toward the OR table reveals a person lying there ALL ALONE, not a soul in sight, with a big wound. There is a stray sponge stick protruding from the wound like a mini flag pole and the hot lights are reflecting of that steel self-retaining retractor.  The mechanical ventilator left unattended by anesthesia is making that rhythmic, ominous whooshing noise. The unattended Yankauer suction gizmo is making a hissing noise like a venomous snake preparing to strike. This scene  used to give me that sick feeling right in the heart of my solar plexus.  It really spooked me.  YIKES!

I think several things here got to me. The stark realization that this was a real person, someone's mother or father, and not just another trauma case. The vulnerability of the person lying there all alone was stark. There should be a team of people in frenzied activity taking care of this person. The loneliness and helplessness was overwhelming. Luckily this lasted only the few seconds it took to get the X-ray and normal activity resumed. I literally ran back to my Mayo stand and was usually the first person to emerge from behind that lead curtain when the X ray was done.  That very brief spooky moment of the patient lying there on that table all alone is really burned into my memory. It still gives me the creeps!

Lacking much of an emotional IQ, I could never really figure why this always spooked me out, but it certainly did the trick. Maybe it was goal interference in that it separated me from what I thought I should do. A loss of control?  I don't know.

Halloweens of yesteryear were always fairly quiet uneventful when I was working. It was mainly just a holiday for the kids. With all the adults celebrating Halloween today, I suspect there is more mayhem necessitating medical attention. I hope all those people toiling in the trenches of todays healthcare systems have a peaceful and uneventful Halloween. I really do appreciate all of you who take the time to indulge in reading my foolishness.  HAPPY HALLOWEEN!

Monday, October 26, 2015

Downey VA Hospital in the News

I was really surprised by the number of people that read my post about "Downey VA Hospital a Lost Empire." I thought that Downey had probably disappeared for good and that there would be little interest. I was going through my collection of old nursing junk memorabilia and lo and behold I came across some yellowed newspaper clippings about assorted trials and tribulations at Downey. As you can see bad press about the VA is not just a recent phenomenon.

From the Suburban Trib May 12, 1975:
The FBI has begin an investigation into the operation of Downey Veterans Hospital. The Suburban Trib learned of the FBI investigation on the heels of an announcement that the General accounting Office was studying the administration of the hospital at Buckley and Green Bay Roads.

Sources will nor specify what FBI agents are studying, except to say the probe is in the initial stages.

F.E. Gathmann, acting Downey Director, said Tuesday that he was not aware of any FBI investigation other than into the murder last month of a 45 year old patient found stabbed at the hospital. A 17 year old Waukeegan IL youth was charged with the murder.

The hospital has recently been embroiled in controversy. John Reeves, a cook at the hospital and president of Local 2017 of  The American Federation of Government Employees, recently charged that former Downey director was transferred because he stepped o too many toes trying to convince the VA to fire incompetent employees.

Reeves has also charged that:
There has been mismanagement of funds at the hospital.
Drugs used in treatment programs are missing.
More attention is being paid to the needs of the Chicago Medical School  formerly  at 2020 Ogden Ave., Chicago than to patients.
Hospital employees have been threatened with reprisals for making public concerns about patient care.

I am not sure of the exact date of the next one, but I think it was from a local newspaper, the Independent Register. Perhaps a bit later than the previous article

Downey Veterans Hospital in North Chicago has launched an investigation into why 7 psychiatric patients took their own lives during the last 11 months.

Hospital administrators told the Independent Register the "suicide rate at Downey is no greater than at like institutions around the country, but what disturbs me is what we can do to spot the potential suicide and stop him before it is too late."

Administrators, who promised a report in two weeks, took action following Lake County Coroner Oscar Lind's charge of lax security at the hospital. Those who died were:

Robert King, 51 a patient who leaped from a 3rd floor window.
Thomas Azzano, 26 a patient who stepped in front of a Northwestern train in North Chicago.
Robert Horwitz, 40, a VA patient who stepped in front of of a train.
Michael O'Mera, 37, a resident patient who jumped in front of a train.
Allen Hamburg,37, a resident patient who committed suicide on the same spot he saw O'Mera die.
James Caba 57, who leaped to his death from atop the hospital water tower.
James Zvala,27, who committed suicide by a medication overdose.

Lind expressed his concern for increased security at the hospital and with the number of pills some of the patients had in their possession at the time of their deaths. "From our investigation...and results we believe this must be negligence," Lind said.

This is from a Chicago Tribune Column from October 29, 1976 by Jeff Lyon called: "The Law on Insanity-Time for its own Trial?"

There is a paradox here.
Wednesday night, security guard Sam Valenti,66 was killed in his cargo-gate guardhouse at O'Hare Airport. He was beaten and stomped so much that his face was caved in. His nose was nearly cut off with a pocket knife.

Police arrested a man outside the guardhouse. they said he was singing when they found him. He told them Valenti had refused to page an airport employee for him and explained his own gashes by saying  he had slipped on Valenti's blood and fell thorough a window.

The man was a former Chicago fireman and Golden Gloves boxing champion James O'Malley, 55. He was indicted for murder before in 1972.

On New Years Day that year, James O'Malley walked into a pizzeria and shot a stranger to death. Moments before he had pistol whipped another man who offered to help move his stalled car. shortly afterwards, O'Malley was found incompetent to stand trial. He would not understand the charges or cooperate with his attorney. He was remanded to the Illinois Department of Mental Health for treatment. Last year he was at last pronounced able to face trial.

During the trial psychiatric testimony was brought before Circuit Judge Romiti: O'Malley had been "schizophrenic," "delusional" at the time of the murder. He had been hearing voices. judge Romiti did what he had to do. He found O'Malley not guilty by reason of insanity. But he also found him in need of further treatment and sent him back to the DMH, apparently confident that mental health authorities would do what they had to do. And that simply, would be to keep n mind O'Malley's past violence and make sure he was well before he was released. That is where Judge Romiti was wrong.

O'Malley spent 22 days at Manteno State Hospital before he was sent to Downey Veterans Administration Hospital on April 21. Downey discharged him on May 26 ruling he could function in society. For nearly five months he did. Until the explosion in Sam Valenti's  guardhouse.

Valenti did not have much time to think much about the aw before being fatally beaten. The law says that if a man is unfit to stand trial, the courts retain jurisdiction. Once he comes to trial, after treatment, he is likely to be found innocent by reason of insanity. That means he is not guilty. It does not mean he is sane. but that's when the courts lose jurisdiction over him; psychiatrists not judges can decide when he returns to society.

The judge can scream as loud as he wants. If Downey VA says he goes out, he goes out.

I had n interesting chat with Marjorie Quant, Administrator at the Downey VA Hospital. Miss Quant said a treatment team of doctors, nurses, social workers, and the like deemed O'Malley ready to be set free. She said she could not reveal what  their reasons were, because of the Federal Privacy Act.

But she said, "I think we followed our normal procedure here. If  you're assuming there was an error here, that would not be correct." When they released O'Malley, did they take into account that he had committed a murder?  "I'm assuming something to that effect would have appeared in the medical history," she said.

Wouldn't that have made a difference? "What made a difference was his medical condition at the time...A patient is discharged only if it is determined he is well enough to live in society. If he is well enough to go home, he has the same rights as anyone else."

Judge Romiti declared Thursday that "you don't just put a bombshell back on the street." DA Bernard Carey called O'Malley's release "outrageous."  There are those who might even call releasing O'Malley from Downey something else. They might call it insane.

Wednesday, October 21, 2015

Atraumatic Suture Needles

This is a scan of a flashcard that I created for myself as a whippersnapperrn. It has held up well over the years, just a bit of yellowing and the tape is starting to deteriorate.  Whenever I wanted to learn something quickly, I made flash cards. Suture needle flashcards had the added incentive to master  names quickly because of the hazard of being stuck with one of the needles when grabbing the card out of your pocket. I know from personal experience that the  Straight Milliner intestinal needle really inflicts a painful and embarrassingly bloody wound. Traumatic needles indeed. Take my word for it, you do not want to see the flash card I made for the different scalpel blades!  It still has a split thickness sample of skin on the #11 blade from the back of my hand. I really learned those blade numbers in  lickety-split  fashion.

After learning the different suture needle names it was time to learn how to thread them. Surgeons could be a persnickety lot and it took considerable time to learn the correct length to cut the suture and position the needle in a  driver at the preferred angle. Suture always came in 48 inch lengths and I could cut it down to either 12 inch or 16 inch lengths in the blink of an eye. Needles and suture material were always packaged separately.

French needles were really easy to thread, just pull the thread through the open back of the needle. Presto! You did it. There is nothing more satisfying than to feel that suture material snap into a French needle for that quick hand-off to a waiting surgeon. It was definitely more fun than threading a needle with a standard eye.

Just when I when I completely mastered handling suture needles, a new product was introduced at our hospital, atraumatic needles. When I first heard this term (atraumatic needle) I thought it was some kind of practical joke. In my experience suture needles were not a major source of trauma in surgery. Trauma came from aggressive retraction where tissues were stretched out like  candy at a taffy pull. How about hacking away at tissue as if you were attempting to open one of those clear plastic clamshell containers? Hey, That's a gall bladder, not a high end HDMI cable! How about using a chisel or curette on an actual living tissue? Now that is trauma and has nothing to do with suture needles. Pulling an extra strand of suture material through tissue, no matter how friable, is really small potatoes compared with other events occurring in the OR.

Atraumatic needles had the end of the suture attached or swadged  directly to the needle. This eliminated the drag from the suture attachment site and extra strand of suture being pulled through  the tissue. A noble accomplishment, but not up to all the hype and ballyhoo that came with their introduction. If you really want to go for the Nobel Prize, think about inventing an atraumatic Balfour Retractor or an atraumatic rib spreader.  Atraumatic needles and  their accompanying  hype were akin to an elephant giving birth to a flea.

Look Ma, No Eyes!

Swage sounds like one of those made up words that pharmaceutical companies developed  to give their product some panache. It does sound more sophisticated than calling them suture needles without eyes or other visible means of  attachment.

There were two methods of swaging suture to a needle. Drill swaging involved boring a hole into the end of the needle, shoving the suture material into the hole and crimping the end of the needle. Channel swaging involved casting the needle with a valley-like depression at the end and positioning suture in the channel and crimping. Channel swaged needles were few and far between and I saved a couple of them. Dexon a new-fangled absorbable suture came channel swaged.

All this atraumatic  foolishness has inspired another great idea. I am off to the  Oldfoolrn  product development institute to work on an atraumatic pillow. Stay tuned!

Sunday, October 18, 2015

Non Glare Surgical Instruments - A Solution to A Problem That Never Existed

"That glare from those surgical instruments is blinding. I'm glad my boyfriend, the football player, gave me that tip about wearing eye black. It works like a charm."  These are the first two characters I have heard complain about surgical instrument glare, but at least they found a solution to their problem without monkeying around with the way surgical instruments are finished which was a true abomination.

It was the Summer of 1970 we were getting a new bunch of surgical residents and a new shipment of surgical instruments. We were habituated to the brilliant shine of highly polished stainless steel instruments. They were so bright they almost glowed, just like the bumper on Daddy's "57 Chevy. We thought they looked nice, the instruments NOT the Chevy and just figured they would be the forever standard in the OR. The surgeons and nurses really did like the shine. It helped delineate the separation of the tissue with the tip of the instrument for the surgeon and looked nice to the nurse when they were set up on a Mayo stand. Why fool with something that everyone likes?

One of the 10 commandments of being a scrub nurse was to NEVER pass a dirty instrument. We always kept a moist 4X4 in our left hand to buff that Babcock up to a beautiful shine before slapping it into the surgeon's hand. The proof of the cleanliness of the instrument was evidenced by it's beautiful shine. I never had a surgeon complain about an instrument being too shiny or that it was a source of glare.

Surgeon complaints about instruments usually involved issues of misaligned points or tips of the instrument, poor or stiff  joint function, and ratchets that released too easily or stiffly. The offending instrument was often "repaired" on the spot by the disgruntled surgeon who destroyed it by bending the handles to a right angle of the functional part of the instrument. This officially retired the instrument and we ordered replacement surgical instruments every Spring.

There was something new and very different with our latest shipment of  surgical instruments. Needle holders or as you whippersnapperns call them needle drivers were a dull grey color with gold handles. We did not know what to make of these bizarre (to us) non-shiny instruments. Dr. Oddo our world famous neurosurgeon was consulted and he did not know what to make of them either and suggested calling the manufacturer. We figured they had missed the polishing part of the manufacturing process and were defective. They certainly looked nasty to our shineophillic eyes.

To our utter amazement we learned these instruments were made to look like this by design. They were "Non glare instruments" and the needle drivers were the camel's nose under the tent, because soon we had non glare hemostats and assorted other permutations of their ilk. We hated them. They looked dirty and no matter how much you rubbed them with a 4X4 would not come clean. Some old time scrub nurses asked, "Can you mix these grey instruments with our polished instruments?" The non glare instruments just did not look right after years of handling the beautiful polished stainless instruments. Comingling them with bright, normal instruments seemed like a sin. Would the yucky matte finish instruments lead the shiny ones astray? We did not know, but did not want to take any chances.

By the time I retired, non glare instruments had completely taken over and most of the young whippersnapperrns looked at me like I was crazy when my reptilian brain reminisced about all the missing shiny stuff. Bright instruments, Gleaming terrazzo floors, brilliant ceramic tiled walls all replaced by miserable matte dull finishes.

A beautiful shiny, proud Babcock


Non-glare. That is one nasty dirty looking Babcock!



Friday, October 16, 2015

Recipe for a Nurse-circa 1930

Hmm... What a tempting target for snarky comments. I guess I should respect the fact that it's from a different time.

Thursday, October 15, 2015

More Foolish Photos

           " The cooking instructions said 2 minutes on high, but this part is still cold.
              I guess I'll have to pop it back in the microwave for another minute."

                                "Stop screaming. These injector guns are completely painless."

"Wow! This has to be the mother of  all tapeworms."
"It's time to check morning temps. Let's see the blue tips are for rectals and the red tips oral or is it the other way around?

Tuesday, October 13, 2015

Medical Uses for Paper Clips

The ordinary paperclip has some novel applications for medical use. In the operating room we had access to an assortment of cutting, drilling, and scraping instruments. Sometimes a simple paper clip can do a more effective job than a surgical instrument. When a clumsy nurse got their finger pinched by a autoclave door clamp, a nasty hematoma developed under the nail. A wise old surgeon was quick with a fast, painless, cheap, and satisfying treatment method for both nurse and doctor.

 I really love some aspects of old time healthcare. If you had a problem and someone had a cure for it, it was done. No insurance company BS. No in network baloney. The problem was fixed.

The paper clip was straightened out and one end heated to red hot by a gas cooking stove in the break room. The red hot end of the paper clip was positioned directly over the hematoma and with light pressure, a drainage hole burned through the nail. This produces a very characteristic odor (like singed hair) because nails are made out of keratin the same protein found in hair. Works like a charm. I suspect the treatment today would involve specialty surgeons, lasers, electric drills, and cost hundreds  of dollars.
WOW.. Talk about a hot foot. The operator here is using a hemostat to hold the paper clip. This is really not necessary. The blowtorch seems like overkill too. When I saw this being done the paperclip was straightened and the very tip of it heated. I think you would have better control with the hand held technique. If you carefully heat just the tip of the paperclip you can hand hold the other end.  The idea is to release pressure as soon as the nail bed is penetrated or the patient will scream in pain. Nail beds are full of nerves.

Dr. Oddo, our internationally famous neurosurgeon, claimed that in 3rd world countries paper clips were used in place of Raney Clips on skin flaps. I guess this would probably be functional and a good example of using what is readily available. A neuro resident once gave Dr. Oddo one of those skeptical, eyerolling type of looks when he was relating the paper clip in lieu of Raney Clip story. Dr Oddo  promptly replied. "The proof is in the pudding. Nurse Fool I want a medicine cup filled with paper clips on your Mayo stand for our next crani."  Dr. Oddo  had a definite penchant for medicine glasses and there was always a line up of glassware on my mayo stand. One glass always held Methylene blue (please see my blue finger bigot post if interested), another held patty sponges in an epinephrine based sauce, and now another one with paper clips. All those glasses lined up made the scrub nurse feel like a bartender at the Biltmore.

 During the surgery, Dr. Oddo deftly applied the paperclips to  the skin flap. I bet this was not the first time he had done this, as he was very adept with handling the paperclips. We were all impressed, but I had a couple of fully loaded Raney Clip appliers ready to go in case one of the paper clips let go. Luckily, it was a brief  short case and all went well. Brief case sounded to businessman like for my taste, but you know what they say about oldfools!

On wet plate X-rays of trauma patients suffering gunshot wounds, radiology residents would mark the exit and entrance wounds with paper clips to serve as reference points for the surgeons  in the OR. The paper clip could even be bent to indicate the suspected direction of the bullet's travel. Paper clips were a crude but effective tool for X-ray marking. Whenever anyone noticed an X-ray with paper clip reference marks it suggested expeditious handling because you knew it belonged to someone with a serious trauma that needed emergency treatment in the OR. We always ran from point A to Point B when moving these films about the hospital.

Surgeons and residents always huddled around the X-ray viewer box before starting the trauma surgery. They were an unusually up tight, anal retentive group, but I could always get them to laugh and relax by calmly asking, "What kind of weapon shoots paper clips?" Surgeons never got tired of this joke and it worked every time especially with a new rotation of residents.

Another use of the lowly paper clip in neuro is for sensory testing of  2 point discrimination. There is a fancy device known as an aesthesiometer  that I have never heard of, but learned about when I googled 2 point discrimination.  An ordinary paper clip works just as well when straightened out and then bent in half. It is easy to bend the paper clip to vary the distance between the points when touching the patients skin.

I bet I am just scratching the surface with these paper clip uses. Does anyone have experience with other paper clip functions in nursing or medicine?

Thursday, October 8, 2015

An Exciting New Product - The Nurse's Helmcapet

For decades, nurses were easily differentiated from other hospital personnel by their stylish white caps. They really bestowed a certain sense of authority to the wearer. Who was going to argue with a tough old nurse in a white cap wielding an 18 gauge needle and asking "Which side would you like it on?"  Nurses caps had a lot  more cred (see I can even talk like one of you whippersnapperns) than those plastic laminated badges with the big letters "RN."

Nurses' caps also served as a non- monetary reward system for nursing students. Every 3 year diploma nurse vividly remembers their capping and banding ceremonies. It really was a big deal and the cap became a badge of honor.

The cap's demise was fueled by a perceived lack of function and nurses probably got tired of caring for them. The closure of 3 year diploma schools was probably the cap's death knell. There has never been a worthy replacement of the nurses' cap. This is about to change.

Now, from the Oldfoolrn  product development institute, I am proud to present the Nurse's Helmcapet. I have spared no offense expense to develop this game changing product.  Originally, my staff wanted to call it simply a helmet cap, but I don't think that sounds nursey or proper.

This cap is very functional and will protect the nurse from swinging trapezes, hanging IV bottles bags (they still hurt) and even patient assaults. It also keeps the nurse's hair up off the shoulder which every diploma graduate knows is a mortal sin worthy a boatload of demerits. Long hair was thought to be an infection hazard that caused as many septic issues as the great plague.The beauty of this innovative new product lies in the marriage of form and function.

It quickly, once the laugher subsides,  identifies the person as a nurse. The plain white prototype model shown below is suitable for a beginning student. For senior student nurses and RNs a traditional black band is added around the lower circumference of the helmcapet with 3/4 inch wide black electrical tape. Now we call it the senior taping ceremony instead of old-fashioned banding. A true melding of tradition with modern practicality.

This is  prototype helmcapet
A production specialist at The OldfoolRN institute carefully inspects The Nurses' Helmcapet. The beautiful and equally functional Helmcapets are awaiting the finishing touch, applying the black band of electrical tape around the base. Note the close scrutiny of the supervisor (right background.)

Watch for another new product launch by the oldfoolrn product development institute. It's called the PenWaScis, a Swiss army knife sort of tool useful to all nurses.  It is a combination pen, watch, and scissors. You can't imagine the utility of this handy dandy  device in such a small package. Just ignore the patient when he asks, "Why are you cutting my dressing off with your watch?" 

Tuesday, October 6, 2015

Foolish Photos II

"Just flip this switch right here and we will be able to listen to Guiding Light"

"Don't worry Mr. Dunkfeather these new robotic circumcision machines never make a mistake."

Oh boy, I have been in this situation many times, being on the hot seat in front the Director of Nursing. It's never a pleasant experience. Here are some possible heinous offenses that would get you called in.

"Nice job polishing your clinic shoes, but you forgot to Clorox the laces. Lets shape up"

"At this institution we wear our caps parallel to our faces NOT on the top of  the head!" This was a common source of complaints from administration. Note how the director is wearing her cap. It doesn't look parallel to me.

"You are wearing black bobbie pins with your white cap. That is improper, they MUST be white."

"You were seen with a white powder substance in your purse. Are you a crack addict?" My response, No it's Polident powder for my dentures. Would you care to sample some?"

Monday, October 5, 2015

Ouch! That Really Smarts

Here are some mishaps that old school nurses faced causing  them to scream OUCH! We were never permitted to swear or raise our voices so a meek little ouch was about the only outburst allowed when being pinched, stabbed, or burned.

Pages  that went into the chart were imprinted by a handy little device known as an Addressograph machine. Each patient had a small plastic card with raised letters and ID numbers. The patient's card was positioned in the machine and the plate with the card pivoted into a rubber roller transferring the information to the paper. This was actually kind of neat. The machine made a reassuring click and whirring noise as it operated which I found rather relaxing. The OUCH resulted when someone, usually in a hurry, bent over close to the machine while it was operating and got a clump of hair twisted around the roller. The Addressograph machine would rip out a patch of hair faster than Moe of the Three Stooges. This was another reasons for nurses to wear caps - to keep hair form being ripped out by that nasty machine. It really did smart and all that giggling from your co-workers did little to soothe the pain.

"Portable" EKG machines used be the size of a grocery cart and when utilized to record the events at a code, required frequent replacement of the rolled paper. The tracing was made on heat sensitive paper with a very hot stylus. Is this technology still in use or has someone figured out how to do this without the burning hot stylus? Anyhow, when rushing to replace the roll of recording paper it was common to get your index finger and/or thumb roasted by contacting the blistering hot stylus. OUCH!

Metal chart holders were spring loaded to keep the pages pinched in place. This worked out great until Miss Butterfingers ( I am speaking from personal experience) neglected to move their finger out of the clamp zone when positioning a report in the chart and closed the spring loaded chart on a finger. OUCH. Now you know how a mouse feels when that trap snaps shuts.

This one really does hurt and can cause injury so don't try to replicate it. Those weighted speculums can get really slippery and have been known to slide right out of your hand in the OR. Just make sure it does not land on your foot. That really smarts and can cause serious damage. I have been thinking of inventing a non-slip version of this instrument, but lack the incentive. I made my fortune from being a scrub nurse, so maybe a nurse entrepreneur somewhere could cash in on this idea.

I hate needle electrodes with a passion. I really think they are inhumane and inflict unnecessary trauma on patients who are already compromised. Once when inserting an electrode, Miss Bruiser, my favorite instructor kept telling me to "slide the needle in more." They were inserted very shallow and almost parallel to the skin. When I inserted the needle as instructed it went straight through the patient's skin into my thumb. I tried to pretend all was well, but Miss Bruiser saw it all and really chewed me out with adjectives like "clumsy, awkward, and inept." I was in pain and totally humiliated. OUCH and OOPS.

Old time traction beds were an OUCH waiting to happen. There were a number of painful scenarios.The trapeze was typically at the same level as the nurse's head when she was providing care. Patients would be pulling at the trapeze while attempting to position themselves then suddenly release the bar causing it to bonk the nurse squarely in the head. If the nurse suddenly raised her head, it was easy to crash into one of the horizontal cross members above. Traction weights could be dropped on a nurse's toes.

Old school nurses never could get used to those new-fangled IV holders that hung from ceiling mounts. Give me a good old pole any day. We were constantly banging our skulls on these overhead hazards. I even witnessed an event that I affectionately call the "skyhook decapitation."  Unbeknownst to her, a nurse got her cap tangled up in the curley- Q hook of the overhead  IV rack and suddenly walked away. Her cap secured by multiple bobby pins was forcibly ripped from her head with a considerable amount of hair. Combine one of these overhead IV  poles with an Adressograph  and you have a formidable hair pulling machine. My scalp hurts just thinking about it.

I really know little about computers. All I know is that I type this and nice people down in that little box read it. Recently, I discovered that many people actually read my foolishness in the middle of the night or bright and early in the morning. I really do not feel worthy of your readership, especially at this hour ( the only writing experience I have is writing operative reports or nursing notes that were not read)  Thanks for giving an old fool something to do and I hope you have an uneventful night! I learned long ago never to wish night nurses a "quiet night."  All hell usually breaks loose after even thinking about that "Q" word.  Wishing for an uneventful night usually does work. At least it doesn't jinx you like that nasty "Q" word.

Saturday, October 3, 2015

Foolish Photos

I found some old photos in my basement that unfortunately lacked captions. Here is what I came up with.
Miss Bruiser, instructor at the school of nursing admonishes one of her charges. "Stop snickering Kathy, I said occipital, NOT ox spittle."

"Yikes! His chest sounds like a Maytag on the rinse cycle"

Student nurses at The County welcome 2 victims volunteers to the nursing arts procedure practice lab. " Today we are doing continuous bladder irrigations. Who wants to be first?" the eager nurses inquire of their hapless "patients. "

"With this new universal scope we can visualize any body cavity through any orifice. When positioning, just be certain to have the correct end of the patient up in the air. Oh, and don't forget to apply a liberal application of Surgi-Lube to the business end of this baby."


Thursday, October 1, 2015

A Linen Closet as Fine Art

I stumbled upon this illustration on Google images and it immediately grabbed my attention.  The fact that it was not currently copyrighted meant that I could use it  which seemed enticing. From the way the shadows cast by the folded sheets create a  3D quality to how the lighting is done to give the nurse an almost ethereal quality really is just fascinating. The photographer must have had a light source within the linen cabinet.  A spectacular view of a really ordinary place.

I learned this photograph was taken in February 1943 by a well known industrial photographer, Robert Yarnall Ritchie. One of his main interests was aviation and aerial photography, but he illustrated a variety of other subjects.

Not surprisingly, this was commissioned by a linen mill, Pepperill Manufacturing at Saro  River Falls in  Bradfford,  Maine. The company was named after Sir William Pepprill a Maine soldier and industrialist. There primary product was sheets and blankets and production was ceased in 1949.

We used to make up "bed packs" and stack them at right angles to one another for easier handling just like the photo illustrates. A bed pack consisted of two flat sheets (fitted sheets were not available), a draw sheet and a pillowcase. The bedpacks were meant to have everything necessary to make a complete bed. The "loose" linen was on the other side of the closet and consisted of individual items like towels, washcloths, and separate sheets.

The hospital where I trained frequently experienced an uncertain supply of certain  linen items. We sometimes would run out of either towels or draw sheets. This prompted  nurses to create  top secret   secondary linen closets in unexpected locations like under sinks in nurses bathrooms or in patients cupboards. It was not unusual to reach for a bottle of IV fluid in the supply room and have a cascade of  drawsheets come raining down. Old school nurses  would do anything for the comfort of their patient even if it wasn't "according to Hoyle." We were always doing something for a patients well being and prefacing the intervention with the explanation  "I know it's not exactly according to Hoyle."  If there was something we could do to  make a patient more comfortable, it was done.

Another nice use for a linen closet was as a sort of meditation chamber to collect your wits after something catastrophic jangled your nerves. Having the walls lined with acoustic dampening linen made the closet a very quiet place even on the busiest of floors. For the full benefit turn out the light, and you have a very peaceful, quiet place to collect your wits before the next disaster unfolds. There are plenty of washcloths to mop up tears so let yourself go.

Linen closets were also an olfactory oasis in a land of putrid, nostril burning smells. The sweet, clean smell of fresh linen was a stark contrast to typical hospital odors. This always worked out well. Most foul smelling events like massive code browns made a trip to the linen cabinet mandatory. It was common to linger in the linen closet and take time to "smell the sheets" before facing unsavory olfactory events. Linen closets really could be the pause that refreshes.

Decades ago linens did not ever travel far from the hospital. There was no contracting out of linen services and everything form laundering, folding and preparation was done right in the hospital building. Our hospital laundry was located in a separate building right smack dab in the middle of a U shaped hospital complex. It was easily identified by the constant output of white clouds of steam. When the linen was worn out it was repurposed into rags or things like scultetus binders. Linen never left the hospital.

I find myself gazing at this photo for long periods of time and really appreciate Robert Yarnall Ritchie for creating such a beautiful image from a different time.