Thursday, December 31, 2020

What Was the Most Viewed Post of 2020?

This has been a really strange year, just when I thought that I'd seen just about every thing, the Corona Virus pops up and attacks some of the most vulnerable members of our population. Dr. Slambow, my surgeon hero of yesteryear, always said it was the things you cannot see that should cause you the most worry. I suspect he was talking about lesions hiding out somewhere in the small bowel, weird anatomical variations, latent coagulopathies  or breaks in sterile technique. Viruses were not on the radar back then, but I thought of Dr. S. many times while the COVID19 mortality and morbidity numbers were flashed across my computer screen. He was right about hidden danger being the ultimate source of worry.

There has been a flight of ideas coursing  through the remnants of my nervous system about subjects to post;  the long tenure of ether screens (anything that lasts for over a century grabs my attention), questionable adjuncts to ventilator therapy (proning, the latest and greatest of these interventions prompted this idea), the demise of doctor's dining rooms, the disappearance of ortho beds with traction frames and a personal tale of TPN addiction.

It's sometimes a long road from an idea to typing up a new post. Declining eyesight and gnarly fingers from IP joint arthritic changes have put the brakes on my once upon a time nimble fingers. My latest status post encephalomyelitis MRI showed a loss of brain volume, so I best get cracking before my vintage memories evaporate in that looming cognitive abyss. Oh well there is always next year and I will strive to post more than once a month which was my 2020 goal.

The most viewed post of 2020 by a swarming plethora of views  was...drum roll please:oldfoolrn: March 2020. I was really taken off guard by the popularity of a post about such an unsavory topic. I think there is a post languishing in my unpublished drafts about every old nurse's favorite colonic, the 1...2...3... enema. Maybe some day I'll hold my nose and publish it, although I was never one for over rated enemas and their associated backside buffonery.

 My personal favorite was about the crude, but effective Wagensteen suction oldfoolrn: Wagensteen Suction - Elegantly Simple Without Electricity In this electonically complex world filled with flat screen monitors and assorted doodads, it's a delight to see a simple mechanical device do it's work. Just because we were ludites doesn't mean we were stupid or lacked creativity.

Happy New year and I appreciate your loyal readership of my never ending  foolishness. You give an old man a sense of deep rooted purpose.

Tuesday, December 15, 2020

Christmas Arrives at Downey VA Hospital With a Gift for Warren



Warren was a big, tall man with a complexion that reminded me of custard pudding, forty-one years old, with half a lifetime spent on the back wards of Downey VA Hospital, a warehouse for the mentally ill. Like most all the patients here he was branded with the diagnosis of schizophrenia, chronic, undifferentiated. By the 1970s psychiatrists had given up on the idea of delineating the various subtypes of the illness; catatonic, hebrephrenic, paranoid, or schizoaffective,  all permutations were treated the same at Downey. Determining the underpinnings and concocting efficacious treatments for complex mental disorders like schizophrenia made nuclear physics look like a game show.The brain was a complex organ with very complex disorders.

Warren's most visible problem was that he was literally lost in space and required constant contact with a wall to do just about anything that required movement. Staff members regarded this as a behavioral manifestation of his psychosis and dealt with it  accordingly by initiating harsh measures like restrictions on privileges such as smoking and moving his bed to a dark, grim, windowless  area for special observation with threats of physical restraint if he persisted in his wall rubbing routine.

Watching Warren navigate the subterranean world of Downey's interconnected tunnel system was like following a bumper car at the state fair. He repeatedly bumped or bounced his right shoulder off the rough red brick walls leaving a trail of textile shards in his wake, similar to the sparks trailed by the bumper car contact wire on the electrified ceiling. His posture resembled the letter "J" upside down with the end of the letter in constant contact with the wall as he gallivanted along his way.

Just about any staff  reprimand, which was nearly constant,  to cease this shirt/coat shredding behavior was meant with a look from Warren that could smelt lead. Out of pure frustration, Warren developed a unique skill that involved tapping on the few panes of glass windows that had not replaced by plexiglass, skillfully he increased the force of the impact until the glass shattered, leaving his hand virtually without injury.

I talked to Warren about his need for wall rubbing and came away with an assessment much different from my esteemed colleagues. I thought the  incessant wall rubbing was not a direct manifestation of his psychosis or voluntary acting out. Warren had a proprioceptive disorder where he really could not tell the position of his body in space. He felt that without contact with the walls while moving he  would follow a circuitous path and never arrive at his destination or fall injuring himself.

That evening while pouring medications my eye was drawn to the heavy plasticized bottle the pharmacy provided for a solution we mixed with Thorazine concentrate liquid to make it palatable. The side and bottom portion of the bottle had a contour that was a near perfect match to Warren's right shoulder where it interfaced with the brick walls.

I took an empty bottle home that evening and went to work on a garment that could slide along those rough Downey walls and remain intact. Warren loved football, having played receiver  in high school, but while his team mates soared to the stars with their lives. he burned up as he plunged back through the atmosphere like the space shuttle Columbia.

After fashioning an appropriate skid plate from the pharmacy bottle, I drilled a series of tiny holes around the periphery of the plastic armor  and carefully sutured sewed the protective armor to the right sleeve of a Chicago Bears jacket  ala a craniotomy bone flap. A test drag across the outside wall of my apartment building proved successful. Warren was an avid Bears fan and I had a feeling he would really enjoy the jacket, especially if he could rub the brick walls without worry.

I carefully wrapped Warren's special Christmas gift complete with the  abrasion tested shoulder armor in a box that was emblazoned with the corporate jingle, "Tarreyton  100's for smokers who would rather fight than switch." He eagerly unwrapped the present half expecting a mother lode of cigarettes, but as he eyed the special jacket, his eyes gleamed. The look was priceless. He quickly donned the jacket with a renewed sense of purpose. When he spotted the shoulder guard, he couldn't wait to try it out with a quick mosey down along the hall walls. It doesn't take much to make some folks happy - one of the special rewards of working at a place like Downey VA Hospital.