Thursday, February 25, 2016

Downey VA Hospital Slang

SUITCASE  - This referred to a patient with multiple complex psychiatric and medical problems . probably derived  from the expression, "This guy has every case but a suitcase"

SATELLITE 5 - This was a reference to the administration building inferring that the workers there were in a different orbit and out of touch with what was actually transpiring on the back  wards.

NAVEL GAZERS - This referred to outside consultants sent in by SATELLITE 5 personnel to provide theoretical solutions to problems of daily life on the back wards. Psychodrama where patients acted out their feelings instead of beating the stew out of someone was an example of an activity a navel gazer came up with. Worked like a charm until the psychodrama leader suffered a broken nose form a dramatic punch.

FUNNY PAPERS - This referred to records or notes made on the ward and not charted.

SLEEPER - This referred to a non committed  patient that suffered a neurosis or drug addiction problem and was sent to one of the chronic wards. They usually only stayed one night and left abruptly the next morning.

G.I. CIGARETTES - Non taxed smokes that were used as a reward system.

BOZO - An inept staff member

HARDCORE - Referred to patient or staff that had been in attendance for > 10 years. It was a toss up as to which group was the most difficult to deal with.

TOPSIDE - Referred to avoidance of the dimly illuminated  inter connecting tunnel system. "I know it's only 15 degrees out there, but I'm going topside."

ACCORDING TO HOYLE - Doing something carefully and by the book regardless of consequences.

TUNE UP - When an interesting patient from the medical component was sent to the psychiatric ward for adjustment of psychotropic medications it was often called referral for a  tune up. I once heard the Chief of Medical Service at Downey bitterly complain to our ward psychiatrist, " I sent that patient to your ward for a tune up and you blew his engine."

ANTISCREAM - A "Downeyism" for any major tranquilizer, usually Thorazine concentrate.

S&S - Short hand for stab and sprint. This was a unique Downey-way of administering an Intramuscular injection to a violent and/or agitated patient. When I was being taught this technique, I was told, "forget everything you know about injection technique." The nurses hand formed a fist with the syringe in the middle and needle pointing down, the thumb was always on the plunger. Whenever a suitable site became available, the syringe was quickly delivered with a stabbing motion and the thumb immediately jammed the plunger home. Whatever became of aspirating and capping the needle? I will have to take the 5th. A crude but effective method that was not according to Hoyle.

PIT - Referred to the restraint room which had 3 bed frames bolted to the floor. I tried playing relaxing music on the radio here and the hardcore nurses made fun of me!

SNAFU - One of my favorites, an old military term for Situation Normal All Foweled Up.

FUBAR - Another military term, Foweled  Up Beyond All Repair. Some people like to substitute another "F" word for fowled but I thought it was nice to maintain a little civility.

PAPER TIGER - A rather loosely applied term for any administrator or outside consultant that came up with rigid authoritarian solutions to everyday backward  back ward  problems. Frequently with impressive academic credentials but no clinical experience. Downey was a haven for these characters. Exhibit "A" would be the employee parking lots which were packed with high-end vehicles any weekday between the hours of 8AM to 4PM.  On weekends and off hours the parking lots were practically deserted  with the exception of a few jalopies belonging to aides and ward nurses like me.  Unlike most of the Panchera Genus, this particular species (paper tiger) is in no danger of extinction. Today I see a plethora of non-clinical nurse geniuses like computer nurses, utilization nurses and nurse infomaniacs with no shortage of grand ideas and schemes to rule the bedside nurse.

I better cease this foolishness before I get carried away. Whenever we were in over our heads in the OR, Dr. Slambow used to always say, "Discretion is the better part of valor." As I quickly loaded Hemoclip  Appliers, I muttered, "To bad you didn't say this 15 minutes ago, before the hepatic bed started bleeding like a stuck pig."  Actually, I never really said that, but the thought did cross my mind.

When I started this foolish blog, I wondered if anyone would read it. My only intent was to write some memories down before my mind topples into that great cognitive abyss that probably is not far off. I never dreamed that I would write 100 posts (this is #100) or that so many people would read my foolishness. Thanks for reading and I am always shocked by the number of people reading this in the middle of the night. A special thanks and I hope that I am not keeping you up.           O.F.

Monday, February 22, 2016

Downey VA Hospital Implements the One Bite Rule

As  you age, events from the past that seemed like an acceptable practice when viewed through the eyes of a youngster come back to haunt you. The event I will be describing seemed like an unusual but acceptable practice when I was a young nurse. Now it just creeps me out and seems cruel and indefensible..

At Downey VA Hospital in the early 1970's there was an expression that said; "The right way...The wrong way...The Downey way."  Downey was an 1800 bed long term psychiatric facility that was the lifelong home for people with serious mental illness.

One of the problems encountered at Downey was patient assaults. Patient to patient - Patient to staff- and patient to civilian (usually innocent visitors.) These assaults were so common that the administration had a form letter prepared for the victims. I don't have a copy, but the essence of it was that Downey was unpredictable, the assault was not a deliberate action, preventive actions are not always successful (no kidding), and we hope you have a speedy recovery. It also went on to state that only a small minority of Downey patients were assaultive which was true.

There were 2 categories of special observation at Downey, Suicidal and Homicidal. For suicidal observation, the patient was always within eyesight and never more than 8 feet distant. You never turned your back on a homicidal patient and tried to keep a physical object like a desk or dresser between you and the patient. A good pair of running shoes was a prudent choice.

We used to have practice  drills using a mattress as a type of shield to corner an assaultive patient and then upon utterance of a previously  agreed code word, have 4 people grab an extremity and transport the patient to a seclusion room where leather restraints were used.

The variety of weapons used in these assaults was unimaginable. I have seen pool balls hurled at such a velocity that they actually chipped brick walls and pool cues used as bats and skewers. The triangular device for racking the pool balls could be forced over a hapless  victims head and used as a collar.

 Ping pong was supposed to be a safe replacement for pool, but I never thought that an ENT consult would be required to remove a ping pong ball from some poor soul's sinuses. What ping pong paddles lacked in mass could be made up by swinging them at a velocity that was probably greater than the speed of sound. I swear, sometimes you could hear the victim scream before the smack of the paddle striking their head.

Another type of assault at Downey was biting. Ears, fingers, arms were all areas prone to receiving human bites. One psychopath actually sharpened his front incisors with a fingernail file and then strutted around smiling menacingly at potential victims. This type of assault was aggressively dealt with at Downey VA.
CAUTION: The one bite rule is being aggressively enforced.

It was widely known that there was a one bite rule in effect at Downey. Whenever anyone received a bite the assaultive patient was told that if this occurred again, all of his teeth would be extracted. There were no appeals or consent, the second bite triggered a full mouth extraction.  This crude, but effective strategy did work. Pulling the teeth worked like removing the bullet from a gun. Not only were the sharp injury producing teeth absent, but the distance the mandible had to move to inflict  a bite  was increased. The increased mandibular travel greatly decreased the pressure of the bite.  I heard one edentulous, assaultive, biting  patient threaten to "gum the hell out of you," but was never able to seriously hurt anyone by gumming.

The patients teeth were extracted in the operating room under general anesthesia. A naso-tracheal intubation was done  which provided anesthesia residents a chance to use Magill forceps. The throat was packed and all teeth were removed. It seemed like a reasonable idea at the time, but now seems barbaric to me.

There was one patient named, "Alfred" who must have been very difficult to deal with. He had both a lobotomy and full mouth extraction done. His hands were in constant pill-rolling motions caused by the Parkinson's induced antipsychotics. I can still visualize his toothless mask like face as he walked up to my med cart for his 2000mg. Thorazine  HS  dose. When I questioned the dose, I was told he had been on it for many years so don't skimp on it. Senior nurses always advised to add a little extra of the Thorazine Concentrate because, "Some of it always sticks to the medicine cup."  I declined.

The treatment of mentally ill patients always bothered me. It would be nice to think that mental health care has improved, but when you consider prisons and jails have become the default provider of mental health services, it's questionable.

Any thoughts?

Saturday, February 20, 2016

A One Handed Shocker

I stumbled upon this illustration from 1910 (before my time) and tried to figure out what it was about without reading the caption.

My first guess was a double duty pill crusher. It even looks like there might be pill residue on the business ends of the two pestle-like gizmos which is a common problem with the assorted pill crushers available today.

 The best way I discovered to crush pills was to place them in a paper soufflĂ© cup, fold it, and crush cup with pills using a hemostat. No clean up and remember it's not wise to crush time released meds. One big SNAFU that I recall was crushing Thodur  pills and producing a hypertensive crisis.

It looks like there are even tethers of some sort on the crushers to prevent them from walking away from the med cart. One sure fire way of preventing things from walking away is to tether them to an old-fashioned metal urinal. We always had a community hemostat for clamping Foleys attached to a metal urinal. If someone attempted to pilfer the hemostat the urinal called attention to the thief by metallic clanging and banging.

Enough of my rambling! According to the caption these are actually electrodes for electroconvulsive therapy form a book entitled Care of the Nervous and Insane.  "The nurse demonstrates the method of holding electrodes in one hand. Held in this way the discs can be held close together or more widely separated. The nurse should practice employing only one hand for the electrodes so the other is free to control the patient."  Those "tethers" are actually conducting wires.

Hopefully, by control of the patient, the text translates to maintaining an airway. I guess there must have been a manpower shortage back in the day if this much was expected of the nurse.

ECT was done when I was a nurse, but it was carefully controlled by anesthetizing the patient with pentothal and sometimes even paralyzing with succinylcholine which of course required an anesthetist. I remember some of the psychiatrists thought a seizure was necessary for ECT to work and avoided the succinylcholine. This always produced impressive and classic tonic-clonic movements.

For some patients ECT seemed to be very beneficial. It seemed strange to me to utilize something that there was no idea how it worked, but I guess most psych drugs were  are  like this. Despite the blowhard attitudes of some of the psychiatrist's, this is a specialty to me that seemed like it was in it's infancy.

Thursday, February 18, 2016


I was always impressed when Dr. Slambow hummed "Home on the Range" in time with his suctioning  and the Bovie providing background bass. Nathan Lee produces the percussion background with tongue slapping and vocalization taking multitasking to another level

Monday, February 15, 2016

How Does Dr. Slambow Select a New Scrub Nurse?

The operating room is fertile ground for the cultivation of some genuine mysteries: Why can Lactated Ringers solution be administered to someone who is not lactating?...How many anatomical variations are there of the cystic duct encountered  in gall bladder surgery?...  Is normal saline solution still normal if used to irrigate abnormal pathology?...Why are some organs present in pairs?.. Why does a needle holder only make a single click when closed on the second ratchet?.. Why  do whippersnapperns call needle holders needle drivers?  I better stop before I drive myself crazy.

I was recruited to be an operating room nurse  by Dr. Slambow, our senior surgeon and procurer of scrub nurses during  my last year of nursing school. A few weeks before graduation, Dr. Slambow called me to his office which was actually located in an old unused operating room at the very end of the hall which was lined with the functional ORs. This was the same room we used for our infamous Thanksgiving turkey autoclave roast. I was scared silly, but Dr. Slambow was actually very pleasant and asked me, "How would you like to be an operating room nurse? I've had my eye on you and think you would do well here."  I was shocked, but knew I wanted to be an operating room nurse since I was knee high to a kick basin.  When I was in high school, the other students were obsessed with attending concerts but I used to love to visit the Museum of Surgery on Michigan Avenue in Chicago. I tired to say yes, but was so overwhelmed that my "Yes"  came out garbled. Dr. Slambow smiled from ear to ear and said, " I will take that as a yes, welcome aboard.You can start the Monday after graduation."

 When  I started working in the OR, I noticed that my colleagues were all very similar in physical size and temperament. I wondered how this all came about and really wanted to solve this mystery. We were all too much alike for this to happen purely by chance. I was also taken aback by Dr. Slambow's  comment that he had his eye on me. The most contact I remember with him occurred at our frequent  nursing school teas. These gala occasions were held afternoons in the cavernous nurses'  lounge which occupied the entire second floor of our nursing school. We celebrated capping, banding, or any event our intrepid instructors wanted to celebrate. Dr. Slambow was a frequent fixture present at these teas usually bringing along one of his surgical residents.

After working with Dr. Slambow and establishing some familiarity, he began to reveal some of  the techniques in his scrub nurse selection process.  I thought he was just being cordial as he attended our events and repeatedly filled our tea cups.  He later confided in me that these teas were his initial evaluation of a "coffle" ( in Dr. Slambow's vernacular) of student nurses. I was shocked to learn the term coffle referred to a group of slaves that were bound together. He always treated us well but I guess slave owners did the same. I always viewed the OR as a kind of plantation after hearing that "coffle" business. It was very clear who was running the show.

He explained that attending nursing tea parties and observing which nurses could drink the most tea without a bathroom trip winnowed the coffle down to a manageable group of potential scrub nurses. Aha! That was why Dr. Slambow kept filling my tea cup and I thought he was just trying to be nice. It was all a part of his selection process.

"My scrub nurses must be tall," Dr. Slambow explained. "I like my instruments to come into my hand from above as if from heaven and that takes a tall nurse to do this. I also like the scrub nurse to look down on the field and anticipate my needs and whims."  Dr. Slambow was only about 5'4" so you did not have to be really tall to meet his criteria and footstools were always available for an extra boost in height. I was a good bit taller and Dr. Slambow seemed to really take a shine to me. So far I had passed the bathroom bladder holding test and met the tallness requirement. Things were looking up.

Dr. Slambow did not like really brainy scrub nurses. Smarts were unnecessary and perhaps dangerous in the OR according to Dr Slambow.  It was not helpful to be very clever or think beyond the current situation. Overthinking a situation frequently leads to calamity in the OR. I remember making a dumb mistake and saying "I never said I was smart."  Dr. Slambow quickly replied that not being too smart was an asset and  had I been really smart he would have never hired me. I think Dr. Slambow had even calculated that a cranial volume to bladder capacity ratio of at least 1:2 was necessary to be a scrub nurse.

Another trick Dr. Slambow employed at out tea parties was the overflowing tea cup caper. He would offer more tea and deliberately overflow the cup spilling hot liquid all over the table. If the student nurse quickly blotted up the tea with a napkin, she was a keeper in the scrub nurse selection process. Nurses that were slow on the draw with a napkin or wiped the tea were better off working in psych according to Dr. Slambow because wiping  away blood from the surgical site in the OR was a good way to dislodge clots. Speed and blotting were the key elements he looked for  here.

Low budget horderves consisting of Sunshine HIHO crackers smothered in canned liver pate' or Red Devil ground ham were always served at our nursing school teas. I liked the way the liver pate' congealed and separated as it rested on the cracker. It always reminded me of a chromatography separation experiment in chemistry class.  They were always served on a giant silver tray. Dr. Slambow would ask an unsuspecting young nurse for a treat from the tray which was too big and unwieldy to pass. If the nurse just selected a cracker at random and passed it to Dr. Slambow she was off the selection list. The correct response was to quickly ask which kind of cracker and expediciously pass it to Dr. Slambow. There were bonus points awarded if he observed the student nurse devouring the liver pate' crackers. They had an offensive texture and odor to some, but I loved them. Dr. Slambow quickly deduced that if a nurse liked liver pate' she probably could tolerate inhaling Bovie smoke and other unsavory sensory events in the operating room.

One of the first commandments a scrub nurse learns is to ALWAYS pass an instrument first to the attending surgeon, residents can wait and if they get smart alecky, crack their knuckles with a sponge ring forcep. (Only do this if you are very experienced or noted Dr. Slambow doing it first.) I was too much of a chicken to try this, but have seen old crusty nurses do it with delight.  Dr. Slambow was frequently accompanied by a bright young surgical resident when attending our teas. If the novice student nurses paid more attention to Dr. Cutrhoid (the resident) than Dr.Slambow she was dimissed as a scrub nurse candidate. Attending surgeons were always top dog. You were not supposed to kiss up to Dr. Cutrhoid, the resident, and  a crack on the knuckles with a tablespoon when he reached for too many horderves may have earned bonus points with Dr. Slambow.

Dr. Slambow did not like any display of emotion and always bragged about how he beat  his fear and anxiety into submission as a resident.  Somehow I always managed to present a cool, calm demeanor even if my heart was racing or I was getting sensory overload from unpleasant stimuli. Sometimes, when stressed my hands would shake, but I developed strategies for this. (Please see my post: Fools Foils For Fasciculating Fingers.)   Dr. Slambow always said you cannot get anything done if you get too emotional and if you were diligent and concentrating only on the task at hand, dangerous emotions could be kept at bay. His theory worked well until something went haywire during a trauma case and Dr. Slambow would vent by yelling at an innocent scrub nurse. I always thought to myself that I did not inflict the trauma or cut a big hole in the poor soul's abdomen: so leave me out of it.  I never engaged with Dr. Slambow   during one of his tantrums.I always thought how paradoxical it was when he talked about how important it was to remain detached and unemotional. Anyhow,  we were all friends at the end of the case when we rehashed events in the break room.

Back in the old days doctors were in charge of virtually everything that happened in the hospital. Hiring and firing, determining length of stay (no pesky utilization reviewers), and the course of treatment. Dr. Slambow was a very patient centered surgeon. He was most happy when a trauma patient we had operated on walked out of the hospital. Finances were of little concern to him; we worked at a genuine charity hospital and Dr. Slambow drove a beat up Volkswagen Bug.

I think of Dr. Slambow whenever I see a health care provider (I hate that term) and the first thing asked for is my insurance card. Dr. Slambow or his office nurse never asked a patient for any financial information, the priority was solving the problem or getting the person back on their feet.
I wish he were around today to tell all the insurance company MBAs, drug salesmen, administrators, and all the permutations of nurses that have bailed from the patient's bedside what he thought of their ilk. It would not be pretty.

This post got way too long and I wanted to describe Dr. Slambow's unique perspective.   Maybe next post. He was the most unusual surgeon I ever scrubbed with. One of his favorite stunts involved swapping roles with the scrub nurse. He would bellow "Nurse go down there and assist Dr. Cutrhoid (the resident). I'm taking over your mayo stand."

Wednesday, February 10, 2016

What in Blue Blazes is Going on Here?

Surgery can be full of  unexpected findings, from bizarre anatomical variations to finding Crohn's disease in the midst of an appendectomy.  Dr. Slambow, my favorite old time general surgeon always hollered out "What in blue blazes is this?"  when he encountered  a surprise. I guess it was his attempt to find a polite way of asking "What the Hell?" Anyhow, that blue blazes  phrase always pops into my mind when I can't figure something out. The above photo circa 1900 really had me stymied. I had to peruse volumes of ancient text before the image was explained. Here are some of my speculations followed by a description of what is actually going on.

It is definitely unpleasant: note the restraining belt on the youngster in the second chair from the left. We used to restrain kids on "papoose" boards with Ace Bandages. It used to creep me out to inflict such trauma an a patient so helpless. Maybe they are budding nurse anesthetists learning how to drip ether on an open mask, on the other hand they look much to alert for this activity. Maybe they are learning how to do tonsillectomies, but why the group treatment? There is little concern for privacy, no wonder they passed the HIPPA law. Maybe it's not so bad and they are just learning how to check temps. Maybe this was before the use of NG tubes and they are force feeding. That person sitting in the back could be the food preparer. Maybe they are learning how to suction after the kids aspirated food. Beats me, it's time to reveal the true action

This is actually a photo depicting the training of dental hygiene personnel. If these are the hygienists, I'm putting my running shoes on before meeting the dentist!

Monday, February 8, 2016

Mini-Paroll - It's Part Transfer Belt and Part Lever

I think it was Archimedes who said, "Give me a big enough lever and a place to stand and I will move the earth." This nifty device looks to be a combination of a transfer belt and a sliding transfer board. I have used the transfer belt and boards independently, but combining the two is a sheer stroke of genius. I even came up with an advertising jingle, "The Mini-Paroll - It's half board and half lever- How clever."  It's probably a good thing that I've made a vast fortune from being a scrub nurse as I don't think I would survive in the advertising business.

I never considered using a transfer board as a lever. We would remove the wheelchair armrest and place one end of the transfer board on the chair while the other end rested on the bed. This formed a bridge that the patient slid across unto the chair. Some patients even learned how to do this independently.

That Mini-Paroll does not look too "mini" to me. It looks somewhat uncomfortable from a patient's perspective to have that board strapped on and then having the nurse apply torque to it. Another problem I see is that while it would work for turning the patient, it would not help with lifting which is where assistance is really needed.

I do not think I would like to see the regular size version of this device with which you could probably apply enough torque to a patients back to cause injury. Another problem I imagine would occur if the patient turned on his own with the Paroll strapped on. It could probably smack the hapless nurse with considerable force. It looks like a novel device, but with some limitations

Friday, February 5, 2016

Patient Lifting and Transfers

"What was that loud cracking noise Susie? My back or your shoulder?"

Patient transfers are to nurses what traffic stops are to police officers, unpredictable and very dangerous. I have known more nurses being disabled from lift related injuries than any other cause. The above photo must have been created by a workman's compensation attorney trying to drum up business. I quickly noted these problems: nurses legs too close together (you want a broad base of support), nurses bent over at waist (my lumbar spine aches just looking at this impending disaster), and the bed should be lowered as close to the floor as possible to minimize the distance of the lift. Fork lift trucks have transmissions and can carry heavy loads in reverse; nurses should never lift in reverse, we evolved to lift facing forward.  Have you ever seen a primate at the zoo lugging anything and walking backwards?  It might also be prudent to equip the patient with some footwear.
In nursing school we were actually presented with a procedure manual for the various lifting techniques . Some of the lifts such as the dreaded Australian Lift were prohibited at our hospital as a result of the number of nurses crippled by the lift. Our beloved instructors like Miss Bruiser explained that  we should learn about the dangerous lifts just so we knew them. This was the same logic applied to Professional Adjustments Class where we were told it would be wise to learn how to smoke a cigarette to be sociable with patients. The learned action could cripple or kill you, but at least you knew how to do it.

The above illustration is a variant of the Australia Lift of which the key elements are 2 nurses with their arms linked together in a wrist lock (death grip) and then lifting together in a coordinated effort. I think the term "Australian" was applied because the lifting force was applied from down under or perhaps it referred to the way a disabled nurse could walk upon completion of the lift - by hopping like a kangaroo. Thankfully, hospitals  in the civilized world have banned this type of lift.

Another dangerous technique is the bear hug lift. The lone nurse approaches the seated patient placing both arms around the chest under the arms and hugs (actually squeezes) the patient as she lifts. Not recommended for recent thoracotomy patients and if any SNAFUS crop up during the execution of this lift 2 people wind up on the floor. This lift may have been the source of the idea for semi-private rooms. A nurse was lifting a patient in his private room fell down with the patient and someone in hospital administration decided to kill 2 birds with one stone and wheeled in an additional bed for the injured nurse.

Another unpleasant lift especially for the patient is the trouser or as we affectionately called it "the wedgie " lift. This procedure mandates the patient wearing pants. With the patient seated and pant zipper down, the nurse grabs the patient's waistband through the unzippered fly and with the other hand on a back belt loop applies the lifting force. With the weight centered, the nurse lifts the patient to a standing position and pivots him into a chair. Good bathroom hygiene is essential or you will definitely mark the patients laundry with this one.

For safe transfer practices, I always found physical therapists to be good resource persons. The key to safety in patient transfers is to avoid lifting completely. Think lateral movement and sliding rather than lifting. My favorite safe transfer technique is called the "demon drop." This involves removing the arm of the chair if possible and positioning it as close to the bed as possible. Elevate the bed so that it is 1-2 inches higher than the chair and slide the patient from the bed to the chair or litter. For a chair to bed transfer position the bed all the way down and slide the patient from the chair to bed.
When I was a young nurse it seems like we were lifting all the time. Every procedure from X-ray to physical therapy required a trip to another hospital department and a lift out of bed into a wheelchair. This was long before workmen's comp and if you did get injured, you were really on your own. I think when nurse injuries from patient lifting cost the corporate hospital money, things began to change. Today patients receive more services in their room so fewer transfers are needed. Toward the end of my life as a nurse, mechanical lifts were in widespread use and manual lifting was not permitted.

There was one instance that I never used a mechanical lift. When transferring a patient's body to the morgue cart, I always felt obligated to personally, with help,  move the body onto the cart. Physically, I never had a difficult time with this. Maybe a body does weigh less after the soul departs or the patient was badly debilitated from illness. In the OR it was possible to raise the table to a level above the cart and it was relatively easy to slide the body onto the cart. Most of these cases were failed trauma cases and as I moved the body to the cart I always thought to myself - "I hope that this poor soul can find the peace that eluded them in this life.


Wednesday, February 3, 2016

The Hoyer Lift - A Boon for Peristalsis

A Hoyer Lift in action. Where in the world is the chair they are transferring into? That nurse standing behind the patient is right in the heart of a danger zone if the lift or sling fails. I think you are going to need a bigger lift or at least spread the legs (on the lift) further apart.
It always excites me when a patient or nurse discovers  a secondary benefit to a nursing intervention or procedure. These are usually serendipity findings and it's like finding a buy one get one free at the supermarket.  Hoyer mechanical  patient lifts have been around for a very long time and are great for bed to chair transfers. These lifts are basically a large steel frame with a boom that can be elevated by pumping a hydraulic jack. Some patients dislike them because the machine and not the nurse is doing all the lifting. One patient even complained that Hoyer Lifts were inhumane because of the lack of physical contact with the nurse during transfer. If anything was inhumane, I believe it was the compressing of  the nurses vertebral discs tighter than a coiled python during the manual lift. I have worked with many nurses that have sustained career ending back injuries during patient lifts, but that's a tale for another post.

The cracking and crunching noise of vertebrae in the nurse's back is replaced by the whooshing noise of a hydraulic jack. Now that is real progress.

I once cared for a quadriplegic named Cecil that managed to incorporate the Hoyer Lift into his bowel routine. We used straps instead of a sling for the patient-lift interface. A narrow 2-3inch strap was placed under Cecil's arms and knees. When the lift was elevated, the straps induced a tight flexion of Cecil's knees toward his chest.  This position combined with the jerky lift motion of the hydraulic jack was perfect for inducing bowel movements. It was simple physics. When the sudden upward motion of the colon decelerated the contents of the bowel remained in motion and promptly exited onto the floor.

The first step was to ascertain the drop zone on the floor and cover the area liberally with blue pads. Next with Cecil in bed on his back we would thread the straps under his arms and knees. We would then lower the bed to increase the lift off area so there would be a maximum number of herkey-jerkey movements with the jack. Next step was to aggressively pump the hydraulic Hoyer lift and pivot Cecil out of bed so he was hanging in mid-air above the blue pad.

The end result was fantastic, essentially a flying code brown. Gravity worked wonders pulling the effluent away from Cecil making clean up a breeze. The combination of the jerkey lifting, flexed at the waist positon and gravity worked every time.
Substitute straps for the sling to provide a bit more flexion at the waist, place blue pads on the floor, pump hydraulic jack like you mean it and PRESTO a flying code brown!
I mastered another bit of foolishness with a Hoyer Lift that used to really entertain Cecil. I would balance myself while lying prone across the center of the lift bar and then raise myself up by reaching over and pumping myself up into the air with the jack. This was a self taught skill and not very professional, but it was well worth it to hear  Cecil laugh like a hyena. For Cecil a great day would include a flying code brown and then watching the nurse self-elevate with The Hoyer Lift. Oh, the simple pleasures of life!