Sunday, June 16, 2019

Head Nurse, Crazy Annie, Implements the Finder's Rule

Long time bedside nurses are just plain different, a breed of their own forged in a cauldron of unspeakable pain, suffering and just plain old garden variety misery. A mystical force motivates these caregivers to give all of themselves in the care of others. Mention self care to one of these hard core nurses and you are apt to get a snoot full of Camel cigarette smoke propelled by the robust laughter. If you were taking care of yourself, you were neglecting patients.

Crazy Annie was one of the most memorable old  nurses I had the experience to work with. Her facial expression reminded me of the Whistler's Mother painting; an aloof stare just waiting for an opportunity to unleash a verbal bomb.  She was a big lady with the arms of a power lifter from transferring patients. One of her innate beliefs was the notion that Hoyer lifts were impersonal and dehumanize the patient. I suggested that back breaking lifts were inhumane for nurses and received  an ear beating that I remember  all too well. Annie did not tolerate fools.

With retirement looming Annie became  even more vociferous with her various edicts about patient care. She believed that nurses should be on their feet the entire shift. "You can't take care of a patient if you are warming a chair," was her admonishment to anyone sitting around the nurse's station. She hollered at me for "holding up the building" when I was so exhausted that I was leaning against the wall in the dirty utility room after an especially grueling session with a balky hopper.

An assistant director of nursing outfitted in her finest attire made the mistake of rounding on Crazy Annie's floor. She was an unwelcome outlier to Annie. Bedside nurses were a tight knit group where people were unimpressed by degrees or rank, but how dedicated they were to caring for the sick. Annie  had a not so latent dislike for nursing administrators and derisively referred to them as "office sitters." I think that's where I picked up the use of the pejorative reference to those nurses who choose to avoid patient care. It might be insubordinate to think so negatively  about those in charge, but it would not be a mistake.

I hope the nurse administrator had room for gloves in her Vuitton Purse.

A fancy dressed, nurse busy body, from administration came strutting up to Crazy Annie with an urgent message. "The patient in room 606 bed 2  is covered in feces."  I smelled trouble in the air as Annie's eyebrows began their little dance as her mind percolated. Annie then started tapping her toe and had that look about her that always made me nervous. She squared herself to the offending nurse office sitter and sternly announced, "I'm instituting the finder's rule on this unit. Whoever finds the mess cleans the mess. Now get to it."

The Gucci nurse was paralyzed as Annie volunteered me as a helper by exclaiming, "Nurse Fool will help you turn the patient to make it easier for you. You look like the type that wears gloves for the unsavory tasks. The Central Supply Cart is in the clean utility room."

I hustled on down to room 606 with the Gucci nurse in tow. Upon arrival, the unsavory nature of the scene began to unfold. It was one of those my cup runeth over type of code brown's to use the whippersnappern  vernacular. A gurgling, gooey, smelly  mess of the highest order. The befuddled office sitter pressed her hands to her cheeks in deep thought. Just as I thought she was about to pitch in and help, she backpedaled like a circus unicyclist into the nearby stairwell.

As I went about the task of making the patient clean and comfortable, I could hear Crazy Annie proudly proclaiming, "I bet we don't see hide nor hair of her for a good long time!" A temporary victory in the land where all wellness is fleeting and office sitters have the final word.

Friday, June 7, 2019

A Shout Out To My Russian Readers

I've been delighted by a sudden increase in pageviews from readers in Russia. It boggles what's left of my foolish mind to realize that I can reach folks so far away from the basement of my humble little hovel. Maybe it's therapeutic to put my reclusiveness on the back burner and extend my foolishness to others.

I had the wonderful experience of working with a Russian educated surgeon - one of the perks of working at a big city academic hospital. I admired how she used her newly acquired English language skills. None of that subject, verb, predicate rigamarole that was drilled into us during high school English class. Direct, no nonsense commands were the order of the day. One of my favorites was, "Fix him to the bed," which meant limit the patient's mobility with a restraining device. "Scissors," became "scissor" because there was only one scissors used at a time. Russian English really made sense and got the point across.

Dr. Ospov, had a couple of unique surgical customs. She loved using long handled needle drivers and forceps. Muscle memory is a powerful force and once acclimated to a long surgical instrument, it's tough to change. Long instruments always amplified any fine tremor present in my lunch hooks fingers so I regarded them with caution. If you want to see an angry surgeon, just try to slip a smaller length needle driver into the mix. Don't fool with muscle memory.

I'm not certain that its a wide spread custom in Russia to eschew prophylactic surgical drains, but Dr. Ospov hated them. Her tight closure of tissues eliminated dead space and  minimized the need for drains. She also liked to throw in a couple of half hitches at the end of suture lines to help maintain the integrity of the closure which seemed like a good idea to me.

I vividly recall one scene that illustrates her no nonsense, get it done approach. We were called to a ward because a patient toppled out of his wheelchair sustaining a nasty occipital skull laceration. When we arrived on the ward, the patient was sprawled out on the floor next to a festive looking Christmas tree. As I prepared to transfer the patient back to the ward for suturing, Dr. Ospov barked, "Grab me a suture set and get down here to help me." The patient was positioned on the floor with his Bye Bye decubiti pad comfortably under his wounded head. I knelt down next to the good doctor as she deftly threw a half dozen sutures in the wound. It was quite a scene with the red blood and green Christmas tree in the background. She really knew how to get things done without a fuss.