Friday, January 31, 2020

A Heminephrectomy and a Stock Tip

I really, really, disliked scrubbing in surgeries that involved partial removal of a kidney. The positioning of the patient  on the OR table involved a number of hacks worthy of a MacGyver  Award.  A side lying position, with a break in the table at the inferior thoracic level was a worthy challenge to maintain with sand bags, chunks of foam egg crate mattress, bean bags sans the beans, rolled up surgical towels, and long lengths of 2 inch adhesive tape which were all  included in the patient  placement armamentarium. Anesthesia was worried about compromised gas exchange with gravity pulling abdominal contents downward on the diaphragm while nurses fretted about a tumble from the table.

Once the procedure was underway the nephrology surgeon began his solemn narrative of all the challenges involved; too much monkeying around near the adrenal glands atop the kidney could blow blood pressures sky high, the renal artery had lots of anatomical variations so it was tough to figure out where it ended and the arcuate artery began, and finally, modifications to the fascia were required to hold what was left of the kidney in place. Old school surgeons just loved to hang the crepe before a difficult procedure because then even a bad result might look OK.

After a lengthy discussion of renal pyramids and poles (I could never make sense out of the difference between the two,)  the surgeon excised the pathologic portion of the kidney that most commonly  harbored a benign tumor or cysts. At least most of the partial nephrectomies offered a cure.

Now the fun part for the hapless scrub nurse begins.  To seal the exposed surface of the incised kidney, miniscule pea sized chunks of fat are sutured in place. This time consuming task requires lots and lots of sutures and by the time about half the job was done my bony fingers were aching from loading endless needle holders.

Fatigue can be the impetus for saying stupid things and my preternatural foolishness didn't help matters as I muttered, "Why don't you just throw a couple of stitches around one big hunk of fat and be done with it."

The surgeon gave me one of those churlish looks and quickly changed the subject to one of his particular areas of expertise, stock marked tips. According to this  financially savvy surgeon,  Abbott labs was a sure fire winner and a must buy stock because the share value had been temporarily  eroded by a contaminated IV fluid SNAFU. As soon as the problem was corrected, the share value would soar. As  he enthusiastically  expounded about this must buy stock, the old Airshields ventilator pumped a potent halogenated anesthetic agent into the deeply obtunded patient.

The case proceeded along uneventfully and I helped gently transfer Mitch, the still anesthetized patient unto the gurney. A nurse was always with a patient like this to maintain an airway on the  open road to the recovery room.  I was carefully making sure his silver metal oral airway (no cheesy plastic throwaways like those in current use)  was in place  as I  guided his mandible forward to keep him breathing.

With unexpected gusto Mitch suddenly aroused, pushing my hand away and yanking out that pesky airway. His first words upon regaining consciousness? "Call my broker. I want in on some of that Abbott Labs stock."

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.