Wednesday, December 28, 2016

Venereal Disease Patient Enlightenment (Old School)

Old, hardened, and down right mean nurses were enough to stimulate the worst in terms of nightmares. Bad dreams that could bestir me from my deepest sleep were close at hand when thoughts of these brutal bats in white arose. They were as tough as they come and capable of smoking an unfiltered cigarette  in two deep puffs. It was an amazing experience watching a cigarette burn down 3/4 inch with a single puff. Their perpetually brown, nicotine  stained fingers always looked like they were involved in a messy code brown. At least one can hope that it was nicotine stains.

 Years of witnessing adverse and unfair outcomes in their patients while working for poverty wages was a catalyst for the formation of a bitter, righteous, and judgmental personality profile. If these tough, white starched gestapo nurses suspected a patient's behavior had a causative component to their health predicament; look out because someone is about to be taught a painful lesson by these old "That'll learn ya" nurses.

The hospital where I trained was a designated facility to treat referrals from the public school system for a variety of infectous diseases. Students that suffered from run of the mill  bacterial infections received very good care unless they had the misfortune to be diagnosed with either syphilis or gonorrhea.  These ailments  were termed venereal diseases before the current terminology of sexually transmitted diseases came about. Venereal disease was loaded with stigma and negative connotations which made it a perfect target for corrective actions at the hands of these painful practitioners with punishment on their agenda.

These old nurses had witnessed the gruesome complications of secondary syphilis with tertiary symptoms such as profound dementia from nervous system involvement.  Infected  students needed to be taught a lesson for their own good. The accepted  treatment for these venereal dieases consisted of a series of painful Bicillin injections administered over a two week course and these old nurses used to get involved in heated arguments over who had the pleasure of inflicting this painful punishment treatment. A stroll through the outpatient waiting room often revealed a trembling youngster curled up in a chair while in the background a couple of nurses would be heard claiming their next victim patient.
Bicillin given with care, is a painful experience. The medication is a thick gooey substance with the consistency of toothpaste that burns like fire when forced into a muscle. These old nurses had ways of making the injection even more memorable painful. As students, we passed through the outpatient area frequently. A common sight was a tearful youngster hobbling from one of  the treatment rooms while vigorously rubbing a wounded rump. The elderly, smirking nurse soon followed twirling the spent glimmering  Bicillin  Tubex  injector like a proud drum major with a baton. We always wondered what was going on here.

On our senior rotation some of these punishment minded ancient  nurses let us in on their  pain inducing trade secrets that were truly bone  chilling. In nursing school we learned tehniques to minimize injection pain, but these old bruisers had quite the opposite in mind for their hapless charges.

The sadistic, aged nurses  said one of the best techniques to enhance injection pain was to inject the viscous Bicillin into a tense muscle by having the victim patient bear weight on the hip being injected. Exposure to cold with open windows in winter enhanced shivering which induced even  more muscle tension. Cold was also an effective agent to make the Bicillin even more thick and irritating.  According to these old nurses, a tense shivering buttock was ripe for injecting with thick ice cold Bicillin. These punishment minded nurses also claimed to have Herculean hand strength that enabled them to inject the thick Bicillin with enough speed to actually tear the   gluteus  muscle. "If you can hear above the crying and screaming, you can actually listen to the muscle tearing," one of them related. Ouch, I envisioned the thick Bicillin acting like the business end of a hemostat being opened while buried in the muscle. That must really smart.
Luckily for the infected students, the Bicillin was made available in prefilled cartridges with a fixed, non-interchangeable 18 guage needle or I am certain these old nurses would be looking for a 16 gauge monster needle. Dulling of the needle did increase pain during skin penetration and this was done by deftly inserting it through the tough rubber on a multi-dose vial a couple of times prior to injection. These punishment minded nurses thought of everything. "If you can see the skin around the needle insertion site retract 1/2 an inch in or so before penetration, you have achieved an appropriate level of needle dullness. This should elicit an audible response from the patient," was the nurses explanation of the procedure.
The ubiquitous isopropyl alcohol foil wrapped pledgets so common today were not available for skin prep  40 years ago. These old nurses were fond of cotton balls soaked to the point of dripping for their prep. Wet alcohol that remains on the skin prior to the injection can be tracked deep into the tissue with the  injection which really stings. Most nurses carefully dry the skin before injecting, but not these punishers that dreamed of alcohol soaked and  quivering buttocks awaiting their painful ministrations.
Nurses were taught to carefully rotate injection sites and make a note of this in the medical record. Punishment nurses followed the same principle as WWII pilots that "bombed on the leader." They carefully administered subsequent injections in the exact same tender site as the previous "leader"  nurse. Recipients of this type of treatment often carried lumps the size of golf balls in their hips from the painful repeated injections.

As a youngster, old nurses could really creep me out. I could see where their mean spiritedness came from but doubt that it benefitted anyone. I guess the most kind way to describe their actions would be to say they were misguided. I sometimes wondered if these aging nurses faced consequences for their self -induced lung cancer from heavy smoking. What's good for the goose is good for the gander.

 I'm thinking about a future post explaining overdose  enlightenment protocols that these punishment minded nurses used.


  1. Ye gods and little fishes!!! And here I thought water boarding was torture!!!

  2. Just reading this makes my butt ache.

    1. The only patients treated worse than STD patients were overdoses. Aggressive suctioning to the point of hacking and bucking off the mattress- just be sure to keep a close eye on that pulse ox!