tag:blogger.com,1999:blog-47237558466990983732024-03-24T12:43:02.818-07:00oldfoolrn"The amazing thing about young fools is how many survive to become old fools" ..... Doug Lauer
Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.comBlogger359125tag:blogger.com,1999:blog-4723755846699098373.post-13177049917386828952023-07-12T17:18:00.002-07:002023-07-12T17:18:24.447-07:00Gastric Freeze-A Cold Hearted Idea<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKSC1eHca38VIBaC2Bv0DcHKvhG0TzprWUjtXF3s6t-S3SR9LobTp6xd45hylGccLpjqCBznCRKtbY1mkMJINY1w_gMg-Xd8HxNWQXfBwxmx-law5QryNyGmWWrsMW-fTw7UZKaAXLbqh-w4oYLuvJwHlYoF2GB6BaamAvVuK5_-zFfd8CVL7ZPY-XLJ0/s500/s-l500.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="500" data-original-width="396" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKSC1eHca38VIBaC2Bv0DcHKvhG0TzprWUjtXF3s6t-S3SR9LobTp6xd45hylGccLpjqCBznCRKtbY1mkMJINY1w_gMg-Xd8HxNWQXfBwxmx-law5QryNyGmWWrsMW-fTw7UZKaAXLbqh-w4oYLuvJwHlYoF2GB6BaamAvVuK5_-zFfd8CVL7ZPY-XLJ0/w316-h400/s-l500.jpg" width="316" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">A stomach freezing machine. That eggplant size balloon<br />in the MDs hand was inserted transesophageally and zero<br />Degree F. ethyl alcohol circulated via a double lumen catheter.</td></tr></tbody></table><br /> Whoever came up with that old medical adage stating if there are 3 or more treatments available for a single ailment, none are effective, was likely talking about duodenal ulcer treatments of the 1960s.Whacky dietary regimens featuring half and half or whole cream as the main ingredient, antacids, and of course tranquilizers because nervous folks suffered from ulcers were medical interventions of the day.<p></p><div>About 15% of ulcer patients had a dismal response to medical treatments and required surgery. The operation of choice was a gastrectomy with or without vagotomy (cutting the nerves that stimulate acid secretion.) This was big time surgery of the day and carried about a 5% mortality rate along with patient dissatisfaction from digestive problems. Every old nurse was acutely aware of the dreaded dumping syndrome where high carbohydrate foods entered the duodenum like greased lightening causing dizziness and occasional fainting.</div><div><br /></div><div>Intractable medical problems like gastric ulcers often produce nonsense like this textbook edict, "The disease is easy to treat but difficult to cure." (That classic was from our Brunner's Nursing textbook.) About one in ten Americans harbored an ulcer and the disease favored men. The combination of lots of suffering folks and the medical mind set to do something... anything... for a cure frequently produced disastrous results. Medical breakthroughs touted on newspaper front pages sometimes proceeded to the obituaries as time passed. Certainly, this was readily evident with frozen stomachs and their hemorrhagic complications.</div><div><br /></div><div>In 1960, a group of surgeons headed by the famous Dr. Wangensteen, inventor of the lifesaving intermittent suction named after him came up with the notion that gastric ulcers could be cured by freezing the stomach. General hypothermia (lowering the body temperature to 86 degrees F. (or 30 degrees C.) was occasionally used to help patients survive brain or cardiac surgery. Under general hypothermia, gastric acid secretion was noted to decrease.</div><div><a href="https://oldfoolrn.blogspot.com/2020/03/wagensteen-suction-elegantly-simple.html">oldfoolrn: Wagensteen Suction - Elegantly Simple Without Electricity</a></div><div><br /></div><div>Dr. Wangensteen questioned, instead of cooling the whole body, what would transpire if only the stomach was chilled? He took the notion one step further and wondered about not merely cooling the stomach, but actually freezing it. I guess he never thought about what happens to a frostbitten ear; it falls off.</div><div><br /></div><div>Desperate for an ulcer cure, freezing the stomach seemed worth a try. A balloon shaped like the stomach and a double lumen catheter to circulate freezing cold ethyl alcohol (zero degrees F.) through the balloon was devised. Experimental trials in animal trials commenced. I could never, ever work in an animal lab with dogs whose internal organs were rearranged and fooled around with in the dubious name of science.</div><div><br /></div><div>One of the bizarre demonstrations of the frozen stomach efficacy was to oxygenate a frog and lower it into the stomach of a live dog. From an untreated stomach the completely digested frog was pulled up 6 hours later. From the frozen dog's stomach the frog would emerge hopping away at a lively pace. Yikes.. and I thought watching my cat vomit mouse parts was disgusting!</div><div><br /></div><div>The May, 1962 <i>Readers Digest </i>ran an article, (They're Freezing Ulcers to Death,) and thousands of patients began demanding the treatment. Maybe they should have renamed the magazine <i>The Digesters Reader! </i>Sorry, blame that one on my foolishness.</div><div><br /></div><div>The medical industrial complex quickly responded and stomach freezing machines were manufactured for eager hospitals and physicians despite the reservations of more conservative practitioners. This was not another innocuous pill that could be discontinued in the event of complications, but an anatomical alteration with the potential of real morbidity and mortality.</div><div><br /></div><div>The gastric freeze did eliminate symptoms for some folks, but the ulcers always returned with virulent ferocity. A few unlucky souls experienced immediate separation of the lining of their stomachs and uncontrolled bleeding which required emergency surgery with sometimes catastrophic loss of life. The gastric freeze treatment lasted about 5 years (1963-1968) before practitioners gave it up. Too many complications with loss of life.</div><div><br /></div><div>A bona fide cure for most gastric ulcers came about when a 1985 article published by Warren and Marshall in The Journal of Gastroenterology described a bacterial infection by H. Pylori as the cause of ulcers. The good doctors proved their point by infecting themselves with the bacteria. an antibiotic regimen proved to be the bonafide cure for gastric ulcers.</div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com4tag:blogger.com,1999:blog-4723755846699098373.post-46588244511016072972023-05-20T12:29:00.003-07:002023-05-20T12:29:32.386-07:00Happy Armed Forces Day!<p> To all those amazing folks on active duty and veterans, you are deeply appreciated and there is really no way to thank-you for the sacrifices you make. I think of you folks daily!</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0tag:blogger.com,1999:blog-4723755846699098373.post-17994055526260590302023-02-14T18:57:00.004-08:002023-02-15T12:27:59.020-08:00On Tenterhooks with Atrial Fibrillation! Despite the pledge I made to myself to refrain from personal health related complaints, here I go with more foolishness about my recent hospitalization. The nurse-turned-patient phenomenon can be fertile ground for peculiar insights into the illness experience.<div><br />I've had episodes of atrial fibrillation now for about 13 years. They are usually no big deal, but combined with a Klebsiella sepsis, the last one was tough to shake off and required more intensive intervention. I was minding my own foolishness in the ER holding area, awaiting an inpatient bed to avail itself when all of a sudden it felt like there was a kettle drum pounding away in my chest. I was going to say that it felt like an elephant sitting on me, but my wife is right, I tend to exaggerate. The medical resident was close by so I told her that my chest was feeling "funny." I really don't like to disclose that I was a nurse to providers so I understate and use foolish vernacular to illustrate my plight. My nursing experiences are too dated to be relevant today.</div><div><br /></div><div>She took a quick listen with a fancy electronic doodad festooned stethoscope and shrieked to a nearby nurse to put me on a monitor. The nurse hastily applied the electrodes, gazed at the monitor with that avian eyeball intensity and flipped out, shrieking to get the crash cart. I was doing just fine up to this point, but in all the ensuing drama, I felt panicked-not a good thing when you are in atrial fib.</div><div><br /></div><div>The arrythmia was promptly converted to normal sinus, but I felt guilty for all the excitement my predicament caused. I was perusing some of the tips for novice nurses on atrial fib that Kati Kleber RN MSN had on her nurse education site, FRESHRN. One of her suggestions really hit home, "Put on your nurse face when caring for a patient in atrial fibrillation." From a patient's perspective, I offer up a hearty AMEN to that one!</div><div><br /></div><div>For all you bright whippersnapperns out there take a gander at FRESHRN. I really admire Kati's fine work and it's a wonderful resource..</div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com3tag:blogger.com,1999:blog-4723755846699098373.post-54214688508731075482023-01-11T18:25:00.000-08:002023-01-11T18:25:22.290-08:00WHAT...Trauma Surgery Cancelled? It's Time for a Fable<p> Every long time nurse is acutely aware that nursing can be a leading cause of "fun" deficit. After so many hours standing behind or in front of your Mayo Stand nothing seems to bring about that good feeling that unabated fun provides. (Maybe it's just my foolishness, but I never could deduce if I was in front of my Mayo Stand or hiding behind it.) It's sorta like that chicken and egg quandary about what came first, but when the surgeon is bellowing, I think it's best to be rearward of your Mayo Stand. Boundaries can be a real asset.</p><p>It happened more often than you would think, the on call gods were restless and that blasted phone arouses the lowly scrub nurse from a peaceful midwinter slumber. The frantic voice on the other end of the blower announces, "Hey fool...up and at 'em, there is a hot trauma in the ER headed your way, it's time to hit it!"</p><p>I scrambled into our trauma room and hastily set up my Mayo and had my back table loaded for bear with enough pieces of sharpened stainless steel for the grandest surgical event known to mankind, Lansing, Michigan! I meticulously scrubbed up at my lucky porcelain scrub sink and my heart was in overdrive, just like a thoroughbred in the starting gate roaring to go.</p><p>Most often, this was the beginning of a long, late night slog involving a gazillion needle holders loaded with aching fingers to patch up shredded hollow viscus organs or lacerated livers. My personal, least favorite patch up job was with damaged kidneys, not only were they tough to access in their retroperitoneal hiding spot but required a significant quantity of little fat balls harvested by the hapless scrub nurse to seal and close severed poles. I once asked Dr. Shambaugh to suture a fist sized fat ball to the exposed glomeruli and be done with it and was promptly rebuked, "It doesn't work that way fool!"</p><p>Occasionally, an anesthesia resident would poke his head in the swinging OR door and proclaim with overtones of gloom and doom, "The surgery is cancelled, pack up and go back to sleep, Fool, and don't forget the bottom bunk is mine." Cancellations were a big letdown for me and in the back of my head, I knew someone had just crossed over to the other side without even getting a second chance in the OR. Trauma surgery cancellectomies had all the ingredients for a sad...sad story.</p><p>So instead of dwelling on death and depression, I would invent alternative realities to the grim happenings. One of my favorite self-told fables was that the poor soul got lucky and managed to sleep it off. What the heck, it was 4:30 AM and everyone else was sound asleep. Everyone is well aware of the regenerative power of a good snooze, well maybe not for massive blunt trauma or big time gunshot wounds, but the notion of a trauma victim sleeping it off was as comforting as petting a lap dog.</p><p>Surgeons and scrub nurses are procedure oriented and live to do things to folks. The sad truth is that most surgical SNAFUS are errors of commission which contrast qualitatively with errors of our non surgical cohorts errors of omission. Maybe this cancellation saved some poor soul from a surgical mishap or foreign body misadventure. HOORAY...that cancellation was a good thing and saved someone from misery and suffering. </p><p>The other mental slight of hand with cancelled emergency surgeries was the notion of a transfer. The fantasy went like this: although we were the only trauma center on the North side of Chicago, the patient was simply moved to another unit or hospital. A much more soothing slight of mindfulness than envisioning a poor soul resting on a hard slab in the morgue cooler.</p><p>Although we are living in the twenty-first century, our emotional responses emanate from a stone age brain. Telling yourself uplifting fables isn't all bad, especially if they allay that sense of paralysis inflicted by a troubled limbic nervous system.</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com2tag:blogger.com,1999:blog-4723755846699098373.post-55826423382727693032022-11-04T18:30:00.014-07:002022-11-15T18:48:33.146-08:00Healthcare Paradoxes<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhov9-5AxWeeqEOpgwx4Mxj4W4xjkIU7LOavQsWQKEt7Arkjq7y03qe1RxeHEhTh2xUxqQ_Ea2tJ2S_p6bsA-nzcbcm5rmRahHMBpT2rOTzOM9-Ieu_lyyUSY-WIueZlouQOvrQgRihFeaVaUt5VFlXhAMaMAH29v3fhbN3IpimUf84vF2G2KHNUfcS/s1366/download%20(1).png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1366" height="324" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhov9-5AxWeeqEOpgwx4Mxj4W4xjkIU7LOavQsWQKEt7Arkjq7y03qe1RxeHEhTh2xUxqQ_Ea2tJ2S_p6bsA-nzcbcm5rmRahHMBpT2rOTzOM9-Ieu_lyyUSY-WIueZlouQOvrQgRihFeaVaUt5VFlXhAMaMAH29v3fhbN3IpimUf84vF2G2KHNUfcS/w577-h324/download%20(1).png" width="577" /></a></div> Wake up! It's time for your sleeping pill.<div><br /></div><div>Go Lytely...This stuff is like a Mount Vesuvius eruption purge in a bottle! Not exactly lightly about anything.</div><div><br /></div><div>Lifesaving surgery...Red Duke, the famous Texas trauma surgeon, debunked this one many moons ago. "When God punches your ticket, he does so with profound authority, without regard to human intervention." </div><div><br /></div><div>Soft code...When the notion that CPR was good for all surfaced, the concept of a muted code emerged: walk, don't run, pediatric compressions for 300 pounders, etc. There really is no such animal as a soft code.</div><div><br /></div><div>Bathroom privileges... This is a biologic need. Do we have room air privileges for patients to breathe?<p></p></div><div>Therapeutic milieu... I learned the fallacy of this one early on at Downey VA hospital. A nurse office sitter was orienting me to my psych unit announcing that this was their "therapeutic milieu" as she opened the locked door to the ward. A pool ball sizzled by my head like it had been launched from a mortar and 2 patients were bayonetting each other over in a corner with a cue, while a third was struggling to remove an impaled rack from his head. Therapeutic??? I don't think so.</div><div><br /></div><div>Normal saline...How normal is an IV solution when it can cause metabolic acidosis and renal function changes?</div><div><br /></div><div>ILL health...Health is health and there is nothing ill about it.</div><div><br /></div><div>Pressure ulcer... Nope, if pressure caused ulcers, divers would be one giant bedsore. It's the shear forces that cause decubitus ulcers.</div><div><br /></div><div>Confined to a wheelchair...As an occasional wheelchair user, this one really grinds my gears. Wheelchairs provide mobility and freedom!</div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com6tag:blogger.com,1999:blog-4723755846699098373.post-13726234076898114032022-10-29T12:28:00.001-07:002022-10-29T18:22:42.160-07:00Fun With Artificial Intelligence Image Generators<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7q8DowejaBZ9xb1I202clZj1wqBJW6UFcEpc2EsE7wTTmIDoZXvs8GQjhKWxO1LdP8nAeb62eqY6fymPYxTcAHbLd92WZUX9rB_yCiDbsUKfCbSpyZu2dMfVLh3h_yhNqJUZ3AJeR4zAfDB1coge0KOGUdttRjST2BWrpdCe_HUMCmV0dtAxEefxc/s512/download%20(4).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="512" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7q8DowejaBZ9xb1I202clZj1wqBJW6UFcEpc2EsE7wTTmIDoZXvs8GQjhKWxO1LdP8nAeb62eqY6fymPYxTcAHbLd92WZUX9rB_yCiDbsUKfCbSpyZu2dMfVLh3h_yhNqJUZ3AJeR4zAfDB1coge0KOGUdttRjST2BWrpdCe_HUMCmV0dtAxEefxc/w286-h286/download%20(4).jpg" width="286" /></a></div>Since my native intelligence has been flumoxed by brain numbing complications from my knee replacement surgery, I've turned to artificial intelligence image generators for some foolish amusement. I typed in Old fool RN on "Stable Diffuusion," an open source image generator and my prompts produced this appropriate image. Maybe I should replace that rather dated blog profile photo of me standing under the overhead lights in the OR. Hmmm...I love how that under the overheads lingo sounds. It doesn't take much to amuse a fool.<p></p><p>If you have an opportunity check out Stable Diffusion. It's easier than a camera or paint brushes to construct images. Hopefully artists and photographers won't be data based out of an occupation, but who knows?</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0tag:blogger.com,1999:blog-4723755846699098373.post-38492289752048909292022-10-23T18:22:00.000-07:002022-10-23T18:22:24.535-07:00Institutional Misogynism: The Women of Downey VA Hospital<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglpCcLUr73XJxMV6AU5QjQkeOeSLhd2exlo7xUHuPMxD4wL7MqAtQxMwNuqeGOjJklxB79bh-NS1Z9MRqKD97J10yk0bPCOBrycv4dhmqrVZAwSjWzkZDDn3BJVwnpmFyBV6rUI2Rq6gNZWIO1q8igMdLxK965vwcNuideItR2JRm0Jgsa2_hjxRn0/s808/mental-asylums-bench.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="808" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglpCcLUr73XJxMV6AU5QjQkeOeSLhd2exlo7xUHuPMxD4wL7MqAtQxMwNuqeGOjJklxB79bh-NS1Z9MRqKD97J10yk0bPCOBrycv4dhmqrVZAwSjWzkZDDn3BJVwnpmFyBV6rUI2Rq6gNZWIO1q8igMdLxK965vwcNuideItR2JRm0Jgsa2_hjxRn0/s320/mental-asylums-bench.jpg" width="317" /></a></div>At the height of the Viet Nam War, Buddhist Monks doused themselves with gasoline and immolated themselves near U.S. facilities to protest America's involvement in the conflict. Two Army nurses rushed to the aid of a monk who set himself ablaze near a remote Army field hospital. A Viet Cong sniper fired on one nurse, killing her instantly. The second nurse, for obscure reasons, was ignored by the sniper and survived. Screaming hysterically and subsequently lapsing into a mute state, the sole survivor eventually found her way to a long-term ward at Downey VA Hospital, a warehouse for the mentally ill. The slain nurse was hailed as a heroine and awarded several posthumous medals and an honorary promotion to Major. A street at Fort Sheridan Army Base was named after her.<p></p><p><i>(A snippet of Downey V.A. Hospital folklore)</i></p><p><br /></p><p>I worked as a nurse at Downey V.A. Hospital for several months before I was aware there were women veterans confined amidst the 1600+ men. One evening I received a frantic phone call from a nurse in Building 135 asking if I could come to their ward and start an IV on a patient who was seizing. My recent medical background was an anomaly among Downey nurses. Most nurses employed there had worked on the back wards for decades, allowing their med-surg skills to atrophy. Eager to be accepted in this strange new land, I let it be known if there was an emergent medical problem, I was available to do what I could.</p><p>I furiously jammed my bit key into the worn slot on the heavy solid steel door on ward 3A, Building 135 and the portal opened briefly and ominously clicked shut. I was shocked to see an emaciated young lady seizing away on the dayroom floor. I should have suspected that any women patients at Downey VA were sequestered in gender segregated silos. At the time, womens' roles in the military were restricted by gender. It was a male dominated world with tentacles that extended to the V.A. psych wards.</p><p>I learned there were two locked female wards at Downey in Building 135 and they were the only ones available in the entire health system. Everyone here was seriously mentally ill and a danger to themselves or others. This arrangement concentrated the most acute patients in one facility while separating them from family and community resources. </p><p>The wards at Downey VA were touted for their therapeutic milieu, but it's a real strain to deduce what could be gained by such profound isolation. There was an on-ward dining room where meals were served to avoid comingling with the young bucks in the communal chow hall. Washers and dryers were also available to reinforce that matronly obligation of wash day duties. The place was a tour de force of isolation and womanly perspicacity.</p><p>Surfacing from my IV start and a hastily administered bolus of Valium, it was readily apparent that the wards in building 135 were much newer than my native Building 66 which was constructed in the 1920s. These contemporary quarters were straight out of the aseptic construction of medical surgical units. The gleaming terrazo floors and ceramic tile walls were more appropriate to an operating room than a place of comfortable lodging and recovery.</p><p>I had the notion that psychiatric units ought to be constructed in the architecture of theaters; not operating rooms. There was no shortage of high drama at Downey V.A. In lieu of a stage, the television assumed the focal point with the viewers numbly looking on like a brace of zombies. The TV came on at seven AM and droned on until bedtime.</p><p>I heard rumors that pregnant women gave birth on the unit and indeed there was an exam room eqipped with a table that sprouted stirrups from it's distal end. Hopefully mothers were carefully screened to delineate complicated deliveries, but you can never assume when it comes to VA care. The facility was loathe to having patients treated in community hospitals and had medical surgical units on site so the men did not have to venture off base for care. Pregnant patients flayed by desperate life circumstances giving birth on a psychiatric unit made me wonder what chance the infant had for a normal life.</p><p>As I eyeballed and wondered what a lone mattress was doing on the dayroom floor, an attendant enlightened me. "We do takedowns differently here. I know you guys over in Building 66 like to countdown and have everyone grab an extremity to apply full leather restraints, but here we just force the unruly patient into a corner using the mattress as a shield and hold them there until they calm down. Visions of a mattress held vertically and used to pin down a patient reminded me of the Chicago Police in their riot gear and shields at the 1968 Democratic Convention riots.</p><p>Walking back to the hallowed halls of building 66 I thought of a cat driven high in a tree by a pack of dogs. Safe at last, but completely isolated like the women in Building 135. Maybe it's time to call the fire department.</p><p></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com4tag:blogger.com,1999:blog-4723755846699098373.post-49149953449753526542022-10-20T18:56:00.000-07:002022-10-20T18:56:09.732-07:00Yep...I'm Still Vertical, Part 2<p> I encountered a tsunami of post-op complications following my total knee replacement surgery in August, but am starting to feel a return to my foolish baseline. I received a fascinating email from Anna Pivoras, Executive Director of the Boone County Museum of History in Belvidere, Ill that got me back to thinking about this much neglected blog.</p><p>Anna read my posts about Downey VA Hospital because she has an amazing collection of journals from a woman who was a patient at this facility. Janet L. was a college graduate who played the organ for several churches and was very ambitious and active in her community. She joined the Army from 1942-1945 and taught kindergarten after leaving the service. She gave the appearance of being highly functional as she was engaged, had a nice car, and apartment.</p><p>After the death of her parents Janet decompensated and was sent to Downey for 3 months in 1967, where "they just wore her out." She became physically ill and was treated and sent back to her ward while still suffering from bouts of nausea. Unfortunately, this was fairly common at Downey. One of my saddest memories is of an elderly man suffering from psychosis as a result of an extended period of time on cardiopulmnary bypass placed in with young psychotic Viet Nam veterans.</p><p>The journals from 1971-1974 document a sad and troubled life with paranoid ideation, She chain smokes, a habit of just about every Downey patient because "GI" cigarettes were free and if you had funds, sold for 27 cents in the canteen. She has constant nightmares about shots, needles, hospitals, and psychiatrists. </p><p>This sad story awakened my memory of the 2 womens' wards at Downey VA Hospital which were pretty much isolated from the rest of the facility. As soon as I can organize my thoughts, (HA...HA) not an easy task in my shape, I hope to get a post together on this forlorn topic.</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0tag:blogger.com,1999:blog-4723755846699098373.post-88797388172872085512022-07-24T12:11:00.001-07:002022-07-24T12:11:19.441-07:00Yep...I'm Still Vertical!<p> I've received several emails recently from folks concerned about my health as a result of the dearth of posts on Oldfoolrn.blogspot.com. It's heart warming to think that you care enough to shoot me an email. When I started this blog, I made myself two promises. no politics and no belly aching about personal health issues.</p><p>I made the mistake of posting one topic that could be construed as political and learned my lesson; no more politics. My immobility problems have worsened as a result of a combination of osteoarthritis and Crohns disease induced poly-arthropathy. Thankfully the intestinal Crohns nonsense has been quiet lately. In 2009 I had both intestinal symptoms and multiple joint arthropathy, not a good combination when you have to double time it to the bathroom! </p><p>Anyhow, I'm finally having a left total knee replacement on August 3rd so I can hobble about my little hovel. I've been occupied with lots of pre-op testing and clearances from a plethora of medicos and everything seems to be all set!</p><p>Meanwhile, I hope some of you can enjoy some of my old posts. The 2 all time most read posts are "Not On My Backtable" and the one on that dreaded operating room nemesis, perineal fallout. You can be sure the first thing I'm going to check out when I'm wheeled into that OR is that rubber bands are in place around the distal portion of everyones' scrub suits. I'm also having this done under spinal anesthesia so I can keep an eye on the goings on!</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com5tag:blogger.com,1999:blog-4723755846699098373.post-62216215573508667472022-05-22T12:58:00.002-07:002022-05-23T18:34:28.053-07:00 Name This Mystery Equipment<p> </p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6N5Z4imX34NNb9cHNdQI_9_AwsGiwFwG9wqTpBheKpZEUa9h1_XQLaewQZah5ZpsNMjpgmGguRa_jVpZrcXVCfM7aJVwkcImLyDNLxx-onUEuqL7YhHxvsfZ9GoC9C7He21M7LGdVAwJnZilS1VjFFeZI1Zo_pJ8X_BSD1O9B6WPwiZ8V98J_uiJR/s4000/20220516_174819.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="4000" data-original-width="1800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6N5Z4imX34NNb9cHNdQI_9_AwsGiwFwG9wqTpBheKpZEUa9h1_XQLaewQZah5ZpsNMjpgmGguRa_jVpZrcXVCfM7aJVwkcImLyDNLxx-onUEuqL7YhHxvsfZ9GoC9C7He21M7LGdVAwJnZilS1VjFFeZI1Zo_pJ8X_BSD1O9B6WPwiZ8V98J_uiJR/s320/20220516_174819.jpg" width="144" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzHIhJY64Qea4xUxRJ_Atnk6qKx8sMcps-ujVQtQ1qu6kV-XLGPuHKqfPbWGx92TDXqu5adT974kNFDQ3Y50NxxDa-2T_eknwV-R4AZi45q_yaVbolj9xxOBfqChYRsnVlJ_3IJAG6UTV0M6YfafvcTuKplSrAx0VqM3zeA7d2mzi8ik2lXa66bkWN/s4000/20220516_174815.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="4000" data-original-width="1800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzHIhJY64Qea4xUxRJ_Atnk6qKx8sMcps-ujVQtQ1qu6kV-XLGPuHKqfPbWGx92TDXqu5adT974kNFDQ3Y50NxxDa-2T_eknwV-R4AZi45q_yaVbolj9xxOBfqChYRsnVlJ_3IJAG6UTV0M6YfafvcTuKplSrAx0VqM3zeA7d2mzi8ik2lXa66bkWN/s320/20220516_174815.jpg" width="144" /></a></div></div><br />I just love hospital mysteries, so I was delighted when a nurse emailed me these photos of a vintage device found in the ER at a Catholic Hospital, St. Vincents, in Cleveland, Ohio. The folks there were unable to identify it and it didn't ring any bells with me so I was thinking (a rare event for me) that maybe someone from my vast readership could lend a clue.<p></p><div>My first guess was that this was some sort of contraption from the hospital laundry. After sheets were dumped from a gigantic steaming cauldron, they were run through rollers to squeeze off excess water. Those rollers were a serious entanglement hazard for the poor folks toiling in this hell with the lid off environment. I had a special place in my heart for the Hispanic crew that worked the hospital laundry. I would practice my lackluster Spanish with these friendly folks and marvel at how happy they were in such an oppressive environment. I had life easy compared to their hardships!</div><div><br /></div><div>My next speculative theory involved the radiology department. Before the advent of automated film processors where raw exposed film was inserted in one end and a finished X-ray slid out the back, roller film processors were used to conserve developer and fixer. The exposed X-ray film was loaded into the roller processors in a darkroom and chemicals introduced by a light proof port. The drum rolled which sloshed the entire film with chemical. You did not need any signage to find the radiology department, just follow the pungent smell of fixer with your proboscis!</div><div><br /></div><div>My next brainstorm (more likely a brain fart) was this was a dispenser for the giant rolls of paper used to cover exam tables. Handling these giant rolls of paper always reminded me of octopus wrestling-get one end secured and the other end would pop up.</div><div><br /></div><div>I did contact Oldfoolette. a central supply queen, from the dark ages and she could not identify it as any medical device. So perhaps the notion of this being a piece of hospital equipment was a cognitive disruption entity. We did have some whacky things in our ER that came in with patients and stayed behind in the ER.</div><div><br /></div><div>We had a Chicago CTA turnstile from the Ravenswood El station that ensnared a fare jumpers lower extremities as he tried to vault over it and save 35 cents. Chicago's finest brought him in turnstile and all. I have a previous post about a poor soul who froze to death in a Chicago Park District garbage can. We kept the can and every time I read that HELP KEEP CHICAGO CLEAN slogan my heart skipped a beat. We kept the tunstile and trash can. Don't ask me why.</div><div><br /></div><div>Any guesses about the identity of the above object would be most welcome! </div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com8tag:blogger.com,1999:blog-4723755846699098373.post-48830113961039858522022-04-23T12:40:00.001-07:002022-04-23T12:45:11.825-07:00Selling Tenormin<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0UBUwUWIjQNX97TF3w2nspm4MsjdLRbDgXELSMzyv8zD4VZIcu6J1JZO3fY9Cpod5WcbDIpNaKpfxIfcJwdfJPwcZXrKwgwky_aQmq5iSld-7gauX4Oaf70zJT6mMwUpJdRkATbuhW_kN94pkLRuRiWR8XUK78mT7IJCoUHBzTxDwp1VB489x7OO4/s1080/drug-rep-tenormin-coins-1989_1_455be79154a5392e9432dd2c52ae5b97.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0UBUwUWIjQNX97TF3w2nspm4MsjdLRbDgXELSMzyv8zD4VZIcu6J1JZO3fY9Cpod5WcbDIpNaKpfxIfcJwdfJPwcZXrKwgwky_aQmq5iSld-7gauX4Oaf70zJT6mMwUpJdRkATbuhW_kN94pkLRuRiWR8XUK78mT7IJCoUHBzTxDwp1VB489x7OO4/s320/drug-rep-tenormin-coins-1989_1_455be79154a5392e9432dd2c52ae5b97.jpg" width="320" /></a></div>What's that old Madison Avenue advertising axiom? If I remember correctly, it's <b>"sell the sizzle not the steak." </b>Sure, every nurse is aware of drug reps acting as poseurs for selling pharmaceuticals with their usual give aways of pens, stationary, and assorted bunk, but when Tenormin went off patent the good folks at Astra Zeneca went bananas with marketing ploys in an attempt to keep the big bucks coming for their name brand gold mine. Tenormin was consistently in the top 20 most frequently prescribed drugs and no doubt brought in gazzilions of dollars which brought smiles to stockholders while cash strapped seniors wolfed down their only affordable meal, Alpo suppers. I knew that trouble was brewing when I learned Alpo only made canine specific meals!<p></p><div>An entire culture was invented to persuade physicians to prescribe the brand name Tenormin in lieu of dirt cheap generic atenolol. Drum roll please...Wellspring was an entire civilization with Tenormin at the apex, invented by clever marketing gurus. There was even a Wellspring magazine with healthy lifestyle tips centered around consumption of this pricey beta blocker. I perused one issue and I was struck by the well tanned healthy youngsters frolicking around a beach. Not a single geezer with a tremulous manner and spreading jowls!</div><div><br /></div><div>The give aways promoting Tenormin were top notch, not your usual cheap pen and stationary give away. Astra Zeneca was well aware that lots of drug company swag found it's way to the circular file, but who in the world would toss a pair of priceless collectible coins? Most physicians were not numismatists and were not aware that the wheat penny featured in the Tenormin collectible coin set was valued at 30 cents and the nickel was likely not worth much more than 5 cents. The fancy encased (I was going to say entombed, but came to my senses,) coin set likely displayed in a prominent place on the good MDs desk as a constant reminder to prescribe Tenormin.</div><div><br /></div><div>For nurses there was the lovely Wellspring wrist watch complete with a lovely red heart smack in the middle of the dial. Internet websites for advertising were far in the future, but Astra Zeneca had a WATS telephone line number (800-937-4027) where you could listen to a prerecorded message touting the benefits of Tenormin. A sweet sounding starlet rambled on and on how Tenormin did not induce depression, so common with other Beta blockers, because it did not cross the blood/brain barrier. Heck, I used to ring her up late at night just to stay awake. There was something about that melodic voice that kept me going. Dr. Slambow was aware of my tricks and when my scrub nurse skills were hampered by fatigue, he would say, "Fool it's time to call that Tenormin lady!"</div><div><br /></div><div>Nursing crises of one sort or another could really shiver your timbers and leave you feel like you were walking a high wire with only cunning and a parasol with the chasm chanting it's siren call way down below. Leave it to Wellspring to come up with a unique antidote for these forlorn times. When the real sh*tstorms rained down on the hapless practitioner. They sprung a genuine Wellspring umbrella as a freebe. My Wellspring parasol lasted all of a couple of hours. While strolling back to my apartment after a late night in the OR, a classic Chicago wind blast destroyed my Wellspring give away. They don't call Chicago the windy city for nothing.</div><div><br /></div><div>There was something about this tour de force of pharmaceutical marketing that shook me in some ways I wasn't even able to name. Wellspring just seemed wrong. Most nurses had a less than favorable view of drug sales folks and likened them to vultures, but I had a different avian vision of these proud hucksters of pharmaceutical wonder drugs. I envisioned drug reps as having all the charms of an old country goose: ordinary with a pleasant demeanor, but an irascible beast that will peck your eyes out when it came down to the hard sell.</div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0tag:blogger.com,1999:blog-4723755846699098373.post-56651499620943237212022-04-02T12:44:00.001-07:002022-04-02T12:47:04.747-07:00I Had The Stew Beat Out Of Me at Downey VA Hospital and All I Got Was This Lousy Letter!<p> </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS76afHNpjMMRIUzlCnv-1mXE2jX1KH2XgEvYT-3M-y36ZG0jbrEmApenJ2w_nRbL6nzTSky_YEtNHKzZMY92RnmooT_QIwwhTe1plIh9Dtc-bddWnfrYZKeS6X_AxHc2uShvd-NoefrLzL5q4q_Y7j00EyUtKOe-P1EC7UYWogsR83laI9L4zRbQ4/s225/s-l225.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="225" data-original-width="225" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS76afHNpjMMRIUzlCnv-1mXE2jX1KH2XgEvYT-3M-y36ZG0jbrEmApenJ2w_nRbL6nzTSky_YEtNHKzZMY92RnmooT_QIwwhTe1plIh9Dtc-bddWnfrYZKeS6X_AxHc2uShvd-NoefrLzL5q4q_Y7j00EyUtKOe-P1EC7UYWogsR83laI9L4zRbQ4/w200-h200/s-l225.jpg" width="200" /></a></div> Veterans Administration Hospital<div> Downey, Illinois 60064</div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div> December 4, 1974 </div><div><br /></div><div><br /></div><div>Mr. Old Fool R.N.</div><div>Nursing Service 118</div><div><br /></div><div><br /></div><div>Dear Mr. Fool:</div><div><br /></div><div>I am sorry to learn of the injury you sustained from a patient's assault. It is regrettable this incident occurred and I am hopeful you have recovered by this time.</div><div><br /></div><div>I am aware that working in a hospital such as ours must be conditioned with a recognized possibility of occasional physical and verbal acting out by patients. Due to the nature of some illnesses, certain patients periodically lose control of their emotions. It is only through the contribution of such as you that the hospital is able to help these patients through their difficult periods and eventually restore them to a fulfilling life in the community.</div><div><br /></div><div>Although you have a positive responsibility to protect and conserve all Federal property, including equipment, supplies, and other equipment entrusted to you, personal remuneration for the broken window you were thrown through will be waived,</div><div><br /></div><div>I want to personally thank you for your assistance as part of the hospital team in carrying out out mission of service to veterans under our care.</div><div><br /></div><div> Sincerely yours,</div><div><br /></div><div> Paul K. Kennedy</div><div> Hospital Director</div><div><br /></div><div><br /></div><div><i>Post script: The VA system has changed quite a bit since this letter was delivered to my mailbox in Building 66 at Downey VA. The official VA seal was updated to replace the anchor and rifle scene with a hodgepodge of images including flags, an eagle, gold cord, and five stars. I think I like the old school seal lots better. There is something to be said for simplicity.</i></div><div><i><br /></i></div><div><i>Patient assaults on staff were so common at Downey that a slew of these letters were written. The VA has subsequently ceased apologizing for assaults to limit their liability. In the 1970s, not a soul would even think about litigation, especially against one's employer. Times have changed.</i></div><div><i><br /></i></div><div><i>If you're interested in the gory details of the assault here is the link; <a href="https://oldfoolrn.blogspot.com/2015/08/knock-out-punch.html">https://oldfoolrn.blogspot.com/2015/08/knock-out-punch.html</a> </i></div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com4tag:blogger.com,1999:blog-4723755846699098373.post-31380959560942092282022-02-25T18:46:00.005-08:002022-03-06T12:21:28.452-08:00Last Night in the OR<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiYb0UrjDBmT13OwJIPM5jpMRRBuNi0PWOn69jq7jw0xbafd03qJDfZ28ZW2M3oB8hfk14Zb7xQ6hTdcloIcRwitxOXzHOKyckoQuz7PC_m7Y2VtXWviZ96QQRUJuQqqP52i5J33lMBv0gd1O8e-CtB2PkHvcAx6PQYtBEJoHjgxfmBNNHDpupcNl28=s658" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="658" data-original-width="555" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEiYb0UrjDBmT13OwJIPM5jpMRRBuNi0PWOn69jq7jw0xbafd03qJDfZ28ZW2M3oB8hfk14Zb7xQ6hTdcloIcRwitxOXzHOKyckoQuz7PC_m7Y2VtXWviZ96QQRUJuQqqP52i5J33lMBv0gd1O8e-CtB2PkHvcAx6PQYtBEJoHjgxfmBNNHDpupcNl28=s320" width="270" /></a></div>Routine scheduled surgery during daylight hours always reminded me of church services on Easter Sunday or Christmas Morning, packed with posers and pretenders making a show of strutting their stuff. Members of the administrative office sitter bunch taking advantage of a new day to spread their feathers like a peacock on parade. The more routine the procedure, the more garish the display.<div><br /><div> Midnight surgeries were of a far different persuasion and akin to a mid-summer church service during vacation season where only the true faithful showed up. The daytime pretenders were a totally different breed from the passionate middle of the night doers. It took a determined personality to crawl out of a warm bed on a frigid Chicago night. Owing to a phobia of authoritative administrators, a craving for an adrenalin boost or a youthful naiveite (choose whatever works for you), I'd rather crawl in for a midnight trauma than scrub for an 8AM vein stripping.<p></p><div>Dr. Slambow, my favorite trauma surgeon had lots to say about these late-night adventures and with his jowls dangling below his mask like a giant croissant he would often bellow. "Everyone here believes in life...so let's get this done before the daytime herd heads through the door." Sometimes he would expound at length as to why the only valid surgical intervention was for serious traumatic injury. "Things can only get better from here, but so many elective procedures invent new surgical complications. When was the last time a radical mastectomy or Whipple really cured anyone?" I could see his point. Thank heaven contemporary surgery with its repair and replace mentality has taken place of the old -ectomy for all free for all's. </div><div><br /></div><div>Middle of night surgeries often began with a call to the honeymoon suite which was actually a repurposed vintage operating room at the end of the hall in the oldest part of the hospital. There were 2 sets of bunk beds and a wall phone midway off the floor so it could be answered by upper or lower occupants of the bunk beds. The room's light switch was permanently taped in the off position with autoclave tape, so entrants did not arouse those at rest. Call rooms like this were gender neutral and the only prerequisite for use was being bone tired.</div><div><br /></div><div>Shenanigans were a great way to pass the time and deal with late night tensions while awaiting that phone call to hop to it. I always tried to set a positive tone for our late-night ministrations and frequently started my dialog with the prep and a lengthy description how I just loved the radiant pinkish glow of Zephirin scrub solution.</div><div><br /></div><div> Janess was a frequent partner on these late-night traumas and I usually bunked on the top bed while we awaited the call god's page. When the call abruptly awakened us at 2AM, a shocker awaited me. I glanced down to put my battle tested Clinics on, and lo and behold, my toenails were painted that lovely pink shade of Zephirin prep solution. Janess just grinned from the lower bunk and admitted she had been busy with nail polish while I was sound asleep.</div><div><br /></div><div>Janess and I had a long history beginning with a procedure partner pairing in nursing school where we bloodied each others arms attempting IV starts. Like so much that happened during our on call trauma . rendezvous, Janess's presence was a paradox. She presided over emergency surgeries like an angel watching a cemetery. She was monumental in a demure sort of manner.</div><div><br /></div><div>The call gods could be an unpredictable lot, but everyone knew to pay close attention to the lunar calendar posted in the light just outside the door. Most nurses did not even bother to rack out when there was a full moon, action was imminent. </div><div><br /></div><div>I never gave a thought to circadian rhythms or the pitfalls of staying hyper alert for late night surgeries when I was young and foolish. Trauma surgery was a mission and I had always sensed that I would be completely lost without it. Looking down at blood spattered shoe covers at the end of a rough trauma, I could never imagine not being a part of this mission. This was timeless. </div><div><br /></div><div>Later in life looking down at varicose veins and arthritic knees, I came to realize I could be just as lost as a result of it. The very thing I thought I needed the most was the thing that drew the shroud of futility around my soul. Helping others while ignoring self-wellness never has a happy ending. and thankfully, most whippersnapperns are more aware of self care than the Oldfoolrns of days gone by.</div></div></div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com7tag:blogger.com,1999:blog-4723755846699098373.post-88126759156166961762022-02-12T13:03:00.006-08:002022-02-16T12:18:44.836-08:00A High-Flying Patient Returns to Earth<p> Usually it's a good sign when you hear a patient coming through the ER with their shrieks echoing off the green tile walls, but with this one, there was a twist. The disheveled, emaciated gentleman was chanting, "I'm breaking a record. get me back up there." Strange indeed.</p><p>As I approached him, a strange combination of olfactory stimuli assaulted my prominent, sensitive beak, a sweet-sour miasma of cigarette smoke and Old Spice cologne to mask the imbedded dirt that made his skin look like a Jackson Pollack work of abstract art. The combination of different colored dirt and a panoply of greenish fungal lesions was a sight to behold.</p><p> I checked the skin turgor on an atrophied bicep and the little mountain of skin generated by the gentle pinch had the staying power of a member of the nurse academic/administrative office sitter complex ensconced in a Lazy Boy recliner. This poor soul was severely dehydrated.</p><p>Of course, in pre-EMS days, the Chicago Police were responsible for most patient transfers, and it was prudent to pay heed to the officer's admission commentary for a history of the patient's injury or treatment insights. The jolly young officer presenting us with our latest challenge had an unusual warning that really piqued our curiosity, "You better be able to rehabilitate this one or you're going to have to order a sitting 'em up coffin for him." Sure enough, the unveiling accomplished by an Abra Cadabra top sheet removal revealed some of the most severe lower leg contractures I have ever seen, with his knees flexed at a 45-degree angle so that a conventional flat, horizontal coffin would never accommodate him. This patient was a poster boy for the hazards of immobility.</p><p>No, this was not a nursing home patient. It was obvious from the poor soul's wrinkled, weathered, and deeply tanned skin that he had spent considerable time communing with the natural world in the good old outdoors. His well tan, wrinkled extremities had the color of tobacco juice and upon removing his tee shirt emblazoned with the slogan "ANGER MANAGEMENT PISSES ME OFF," a few scraggly chest hairs emerged from a chest that looked like the color of skim milk.</p><p>Perhaps a hiker who experienced a mishap on the trail or a construction worker? The patient was strangely nonverbal when queried about his plight, and as the mystery deepened, we decided that treating his dehydration would be a good place to start. His serum osmols were sky high and poor skin turgor cried out for hydration. </p><p>We lacked that clever whippersnappern vernacular back in the day, but the new fangled term "fluid resuscitation" described what was acutely needed here. Unfortunately, a cursory review of his arms revealed that finding a vein was going to be like looking for a black cat in a coal mine. I corralled the friendly resident to place a central line. He opted to place it in the subclavian vein running just below the clavicle. He punctured the big vein with ease and after verifying a good, nonpulsatile flow began threading the guide wire through the needle. After sliding the catheter in we were in business.</p><p>It didn't take long for our efforts to bear fruit and the poor soul began relating his adventurous, but misguided tale. He had been hired by a newly established whiskey distillery on Lincoln Avenue to set a flag pole sitting record as a publicity stunt. This activity, popular in the 1920s and resurrected in the 1960s was exactly as described. Our patient had been confined to a whiskey barrel platform erected on the very tip of a 60 foot flag pole. He was planning to break a 30 day record but was retired after several weeks when his ground crew could not communicate with him and called the Chicago police who delivered him to our ER. </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjqn9uVU4ZDrstYpjclGvcnr6tarioU5Pzph5ivLbfrS0XGgoowBsq5Ho28f5lYoGwRCohCbcwb4vFyNwCZj9zGa0HMNnOMOn5db21CoGKiYOPS8QnRgEKgU95Z9AZyvHwAX1xOkiYP9GKXJPJs4IL4BO3FSaICJ4O6AVIMMtPtOlIRbP5ldhuby4YK=s568" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="568" data-original-width="474" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEjqn9uVU4ZDrstYpjclGvcnr6tarioU5Pzph5ivLbfrS0XGgoowBsq5Ho28f5lYoGwRCohCbcwb4vFyNwCZj9zGa0HMNnOMOn5db21CoGKiYOPS8QnRgEKgU95Z9AZyvHwAX1xOkiYP9GKXJPJs4IL4BO3FSaICJ4O6AVIMMtPtOlIRbP5ldhuby4YK=s320" width="267" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">What goes up, must come down</td></tr></tbody></table><br /><p>Before internet advertising, business had to invent a number of whacky schemes to promote their ventures. Oscar Mayer company had a vehicle resembling a hot dog on 4 wheels aptly called the wienermobile and it was piloted by none other than Little Oscar. Car dealerships used high voltage floodlights to illuminate the night sky and bring in customers. Like the emaciated flag pole sitter some of these promotions ended in a trip to the hospital. Lincoln Mercury had a genuine Cougar on hand at Chicago's Ampitheater auto show and all was hunky dory until the beast attacked his trainer.</p><p>It's a good reason that hospitals were not allowed to advertise or I suspect misguided CEOs would have considered a nurse for flag pole sitting duty. They expected us to perform just about any unsavory or unpleasant task imaginable.</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p>' </p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com7tag:blogger.com,1999:blog-4723755846699098373.post-89258865120020744632022-01-30T13:35:00.003-08:002022-01-30T13:39:10.415-08:00The Gas House Gang<p> </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiQ1NFzozgBdLGjNFiUqqDB_eZdLRsJaR8j4fCE7ruhQmHQrv0vcnAKyuDUe1Nh2O3Gf3f3aV5pIc1JZ09YEIzJg-x4fSMh2hUHoyszW7B810fhwdtQ1l0jAnnS4pw-B1BPdit0hxamF28Oh5h8hBARvhhnfdoDVyNUeCGhmjCQvrnjN2tJpKTf9ZBf=s1571" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1194" data-original-width="1571" height="304" src="https://blogger.googleusercontent.com/img/a/AVvXsEiQ1NFzozgBdLGjNFiUqqDB_eZdLRsJaR8j4fCE7ruhQmHQrv0vcnAKyuDUe1Nh2O3Gf3f3aV5pIc1JZ09YEIzJg-x4fSMh2hUHoyszW7B810fhwdtQ1l0jAnnS4pw-B1BPdit0hxamF28Oh5h8hBARvhhnfdoDVyNUeCGhmjCQvrnjN2tJpKTf9ZBf=w400-h304" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><b><br />Who knew a nitrous oxide leak could lead to so much fun??</b><br /><br /></td></tr></tbody></table><p></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com4tag:blogger.com,1999:blog-4723755846699098373.post-20913917120987630912022-01-27T13:02:00.001-08:002022-01-27T18:25:08.283-08:00Life Before Piped in Oxygen - Tanks A Lot<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><img alt="" border="0" data-original-height="600" data-original-width="401" height="345" src="https://blogger.googleusercontent.com/img/a/AVvXsEhu06spiEokg_lgtAFlD2gecmbFOVYBhU2bxt7c4d2zLPy7MVPdGoVrYIHpsBb3qJzpycqqo62udhRCwZcjJ9imefQ0TXRxwDssov8HCYOt6ItzNTm41gu_KcY69Q7L0_2IsatSJnb-vyunf9wm8uaHVpLf9ntTTzpYo0IDAOF0bubt2ICxq6YXTX2s=w230-h345" style="margin-left: auto; margin-right: auto;" width="230" /></td></tr><tr><td class="tr-caption" style="text-align: center;">Physiology pivots on the oxygen pinnacle<br /><br /></td></tr></tbody></table><div>I thought those gigantic "H" cylinders of oxygen, not to be confused with their lesser sized brotherern, would be with us forever in the hospital. Oxygen delivered to wall outlets in patient's rooms seemed like a pipe dream because we had enough problems with our common old ordinary plumbing. There were steam leaks from autoclave pipes that resembled Old Faithful and recurrent problems with clogged drains. Pipes and problems went together like tweedle dee and tweedle dumb. How in the world could this ever work with a gas under high pressure?</div><div><br /></div><div>I couldn't imagine oxygen pipes being exempt from similar pipe problems and, of course, I was an ace with the skills necessary to course these massive green cylinders around and about hospital wards and halls. Who needs fancy piped in O2? A weak mind and a strong back were the only prerequisites for being an oxygen delivery boy, and of course the eager nurses and cyanotic patients were always overjoyed to see me with my life sustaining cargo. Just what a fragile adolescent male cast adrift in a sea of estrogen needed for an ego boost. I was really doing something worthwhile! This is why I chose nursing as a career instead of an auto mechanic.</div><div><br /></div><div>Oxygen tank storage rooms were special places and out of bounds for most of the fairer sex. Green monsters chained to 2X12 wooden planks and weighing in at over 150 pounds required some muscle and lots of practice to safely handle. I used a trusty dolly to transport these bemouths and once they were set in motion inertia took over. Stopping these rolling monsters was akin to putting the brakes on a battleship.</div><div><br /></div><div><a href="https://blogger.googleusercontent.com/img/a/AVvXsEirHDdDz2dIi5xkL2faZWr2JFH6vHTClWo9hcProQQfCNGFcEQFk0wtg4uEj2HkJVHog8D6jJyiq_a1TpSHLPXc5gS8g5RjVfsxWFCv9DUXAVdFT6La3XUteCenypF6hDrhDy7OW5nd8CA_fl-709-dzIjeZosllJZeXRrJMS2F3vVvpginktD4mT03=s550" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="550" data-original-width="386" height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEirHDdDz2dIi5xkL2faZWr2JFH6vHTClWo9hcProQQfCNGFcEQFk0wtg4uEj2HkJVHog8D6jJyiq_a1TpSHLPXc5gS8g5RjVfsxWFCv9DUXAVdFT6La3XUteCenypF6hDrhDy7OW5nd8CA_fl-709-dzIjeZosllJZeXRrJMS2F3vVvpginktD4mT03=w141-h200" width="141" /></a>The other tricky part was maintaining the correct incline while tipping the dolly into position. There were dollys with training wheels for the more cautious, but the tiny caster like wheels used on the trainer support system were prone to gyrating like a belly dancer and slowing the entire delivery process. It was no fun pushing these bruisers down a hospital corridor with those tiny wheels doing the watutsi.</div><div><br /></div><div>Training wheels also impaired the ability to maneuver the tank into position at the patient's bedside. It was possible to fine tune the position of the tanks when it was released from the dolly by carefully rolling the base of the tank which was all fun and games until you rolled an "H" cylinder over your toes. I preferred the dolly sans training wheels.</div><div><br /></div><div>Alas, all good things must come to an end, and the conversion of cavernous hospital wards to semi-private rooms was a game changer. Wrestling a colossal "H" oxygen cylinder into the cramped confines of puny 2 bed hospital room was akin to stuffing an elephant into a phone booth, these green monsters longed for the circus big top of a spacious ward where there was ample room to roam.</div><div><br /></div><div>The construction required to section off individual rooms from the big tent arena of a hospital ward provided an opportunity to run pipelines for the bedside delivery of oxygen, and an end to wrestling with the big green monsters.</div><div><br /></div><div>Endings like this are usually bittersweet. Yes, piped in oxygen was very convenient, but the bedside delivery of something as life sustaining as oxygen afforded the delivery boy an entire cosmos of goodwill. It was heartwarming to witness the relief and gratitude of patients and nurses alike, while I quickly switched out regulator yokes and twisted my oxygen wrench to the on position and noted the swing of the needle on the pressure gauge from near empty to full, good for another few days of life sustaining oxygen. I was transformed from lowly delivery boy to a genuine care giver and that was good enough for me.</div><div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div><br /></div><br /></div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com2tag:blogger.com,1999:blog-4723755846699098373.post-21010375347708387932022-01-03T12:38:00.004-08:002022-01-03T18:36:00.662-08:00Roller Clamps Were Pioneers in IV Fluid Regulation<p> </p><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjlgxDnQxBOJZOhw_3zdirGr-3lzPTEDr_ZbhIWrPNWz_YYnyh7KOeJ5CnpzIFaWwBvsjLIQOl6eQDQiRXm-u9TJoWYz022NeD8_FEZberlrQxlw1sUzLPSeTxRkyY5v2VM7suatG2cq4VQ4viKEKdLnZy-b5hj0ciQwNy3B1w_5v8oFEHGkbTkK6MJ=s500"><img border="0" data-original-height="412" data-original-width="500" height="264" src="https://blogger.googleusercontent.com/img/a/AVvXsEjlgxDnQxBOJZOhw_3zdirGr-3lzPTEDr_ZbhIWrPNWz_YYnyh7KOeJ5CnpzIFaWwBvsjLIQOl6eQDQiRXm-u9TJoWYz022NeD8_FEZberlrQxlw1sUzLPSeTxRkyY5v2VM7suatG2cq4VQ4viKEKdLnZy-b5hj0ciQwNy3B1w_5v8oFEHGkbTkK6MJ=s320" width="320" /></a></div>The past is like a foreign country where things are done differently, before the extravagant complexity of intravenous pumps and controllers, simple little roller clamps ruled the roost when it came to IV regulation. I was totally fascinated by these clever little gizmos and even had a collection of vintage roller clamps that I recently unearthed from my <strike>nursing archives</strike> basement junk hoard. <br /><p></p><p>These unsung heroes of the IV therapy universe deserve further study as they are not as simple as they appear. An injection molded cage with wheel guides molded into the sides to accept the axles of the adjustment wheel is the most obvious feature. When the wheel is positioned at the top of the housing an uncompromised flow of IV fluid ensues. The device must apply just the right amount of friction to the plastic tube to remain stationary while leaving the lumen of the IV tube wide open, not an easy task. The device then had to regulate the flow of IV fluid by changing the lumen of the IV tubing as the nurse turned the adjustment wheel.</p><p>There was strict dogma delineating the correct position of the clamp on the tubing. Our rigid, uncompromising diploma school instructors insisted on having the roller clamp positioned about 2 inches below the drip chamber so as to be able to locate it in the dark. Old nurses never, ever flashed on blinding overhead room lights at night. Sleep was revered as a healing agent. Having the clamp just below the drip chamber made it easy to locate at night.</p><p>There were 2 methods of establishing a flow control region within the clamp housing and one entailed the wheel traveling along an inclined ramp molded into the bottom wall of the device. The other entailed a clamp with the base parallel to the open wheel access port, not a ramp in sight! The wheel guides were inclined so the wheel traveled at an angle to the base of the clamp whereas the wheel was much closer to the bottom of the clamp when rolled down. The pressure on the IV tubing was varied by the up and down movement control wheel as it moved along the inclinations in the wheel guides.</p><p>Some really fancy roller clamps were dual action in that both a ramp and a variable inclinable control wheel changed the lumen of the IV tube. Some things in nursing made no sense and one of the most common places to find these over engineered, exquisite roller clamps was on clysis sets that were used to give fluids subcutaneously. Drip regulation on clysis sets was not a big deal, so why the fancy roller clamps? Some mysteries are never solved, especially in nursing, but that's a topic for another day.</p><p> Clysis sets were really old school and not subject to medical supply companies seeking to maximize profit margins by making cheaper roller clamps. Travenol clysis sets with dual action clamps even had metal axle spindles on the control wheels. I'm sure it would have been more cost effective to injection mold the wheel and axle in one piece. No cost was spared in producing these roller clamp gems.( For more foolishness on clysis: <a href="https://oldfoolrn.blogspot.com/2015/07/down-quart-hypodermoclysis-to-rescue.html">https://oldfoolrn.blogspot.com/2015/07/down-quart-hypodermoclysis-to-rescue.html</a> . )</p><p>One of the problems with roller clamps was a phenomenon called control point drift which occurred when the control wheel spontaneously moved to a region of less pressure increasing the lumen of the IV tube resulting in increased flow rate. Definitely not a good thing, especially when titrating vasopressors. The dual action clamps with metal control wheels were rock solid once adjusted. The increased friction exerted by the metal spindles effectively attenuated control point drift.</p><p>Another problem with roller clamps involved the properties of the PVC intravenous tubing itself. After adjustment a phenomenon known as cold flow creep sometimes occurred. The lumen of the IV tube would decrease even though there was no movement of the control wheel. Lengthening the control zone on the clamp helped control this problem. Generally speaking, the longer the roller clamp the more stable the infusion rate. Short, stout roller clamps could be a real bear to regulate, some nurses even resorted to taping the control wheel in place.</p><p>The labor investment required by manual IV control was considerable because roller clamps needed frequent adjustment, but who would you like to see standing at your bedside, a concerned nurse or a noise barfing electronic poseur? Roller clamps also limited the number of IVs that could be managed on a ward. On a 30 bed unit the maximum number of running IVs was abour six. Roller clamps are long gone, but not forgotten.<br /></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com14tag:blogger.com,1999:blog-4723755846699098373.post-18180511364024762832021-12-15T15:28:00.001-08:002021-12-21T12:07:54.853-08:00Rethinking Nursing Awards<p>It's been many moons since I've posted and I'm certain all three of my regular readers miss my foolishness as much as I miss their astute comments. When it comes down to posting on my blog or navel gazing, the later always seems to win out.</p><p> I wonder how anyone can be a regular reader of an intermittent blogger unless they are like regularly irregular like cardiac arrhythmias,...oops there I go with more of that philosophical navel gazing stuff. Well it's time to grind out some of that patented foolishness that I'm famous for and what better place to start than with that time honored tradition of nursing awards?</p><p>I've noted a recent plethora of nonsensical nursing awards. Let's see there is the ever popular Daisey award and the Rubber Duckey award (No foolin'). One medical center was even handing out rocks as an award. Strange indeed. Most of the folks handing out nurse awards are hard core members of the dreaded nurse academic/administrative office sitter complex who have mastered a type of feel good jargon with absolutely no clue about what actually transpires during bedside nursing care. Without further ado let's get into some real world nursing awards from the perspective of the tried and true bedside practitioner.</p><p>The first award is the aptly named The Golden Goose award which is given to the most whacky and useless nursing research project. I never could deduce the role of nursing research which should be aligned with biology and physiology, not psychology and sociology. What's wrong with clinical research if our goal is to improve patient care?</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOj4Blv9KOUWdEKA1SbKhiAAJMJvR3PQRXf0Aj3rBTyzGg83NhPOuHXWMNPcRN4MYKAMBDwD6dktdLS6REpLuMHQMP6Yn9gc8-_AYY2cGNa6KlNLFn8ScHicPapX57sxU8y4whOq4J7c/s603/47693432_359718734825441_4634581097192153144_n%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="603" data-original-width="538" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJOj4Blv9KOUWdEKA1SbKhiAAJMJvR3PQRXf0Aj3rBTyzGg83NhPOuHXWMNPcRN4MYKAMBDwD6dktdLS6REpLuMHQMP6Yn9gc8-_AYY2cGNa6KlNLFn8ScHicPapX57sxU8y4whOq4J7c/s320/47693432_359718734825441_4634581097192153144_n%25281%2529.jpg" width="286" /></a></div>Drumroll please...the Golden Goose is awarded to a study with the impressive question; "Does photic stimulation impact hypovigilant states in the hospitalized patient?" If a research question can be easily answered, it's probably not a good one to study, and heck yes, turning on the sonic boom equivalent of lighting in a hospital room wakes patients up. We used to sneak around with great stealth using flashlights so I cannot understand where the notion of turning on the bright overhead lights came from.<p></p><p></p><p>I suspect it might have something to do with utilization review nurses and their never-ending quest to give patients the boot out the front door ASAP. Making the hospital environment as inhospitable as possible is a fail safe method to encourage patient egress in an expedicious manner.</p><p><br /></p><p>My next award is aptly named "The Bermuda Triangle" and Head nurse Annie whose exploits I've detailed in a previous post is the hands down winner of this honor. Annie's fait accompli was making problems disappear into thin air. One memorable escapade involved a litigious patient falling from an allegedly defective hospital bed. The bed had been sequestered in an unused room awaiting inspection by a representative from the plaintiff's lawyer. Annie contacted a nursing school on the other side of the city and offered them a free bed for their nursing practice lab. All they had to do was provide transportation which was arranged through a friendly police officer hanging out in the ER. In Chicago, paddy wagons are called "squadrols" and they just happened to perfectly accommodate a hospital bed.</p><p>The Marcel Marceau Award goes to one of my favorite OR colleagues, Janess, who was a strict devotee of that old school axiom that scrub nurses are better seen than heard. Every OR nurse recognizes the wrist flick gesture for a needle holder or the index, 2nd finger sign for scissors. but Janess had a few special movements that were just between us. A modified throat slashing gesture meant that our dreaded nemesis, Alice, the noisebarfing supervisor was approaching with her usual dose of venom and it was time to lay low. She also had a unique taffey pulling like gesture for a retractor that was most impressive and cemented her qualifications to receive such an esteemed honor.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhSw4uXmZMGStU09tP3C2qNWR01Se-eQ4mKjflG4FKtc8g0w6JyB_wX13cl57egaSeL1HNWPJWaF8xSGR4kBvbTaAN1Z8EU2gCFwSt0-KoPB_vvoDsS3-7qZKC4lyjfDbzNoBTLxaydZyJN9YaEhPPGATRFag3JP0TTyGNvWyInsQ3DVLeHnWaT2azY=s1280" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="848" data-original-width="1280" height="212" src="https://blogger.googleusercontent.com/img/a/AVvXsEhSw4uXmZMGStU09tP3C2qNWR01Se-eQ4mKjflG4FKtc8g0w6JyB_wX13cl57egaSeL1HNWPJWaF8xSGR4kBvbTaAN1Z8EU2gCFwSt0-KoPB_vvoDsS3-7qZKC4lyjfDbzNoBTLxaydZyJN9YaEhPPGATRFag3JP0TTyGNvWyInsQ3DVLeHnWaT2azY=s320" width="320" /></a></div>The next award is really something special and it's called the starfish award, coined after the aquatic creature's unique ability to heal on its own accord by growing new limbs. Corazon Amuro is the deserving recipient of this honor.<p></p><p>She was the sole survivor of a demented serial killer named Richard Speck who invaded a Chicago apartment where 9 student nurses were living. Ms. Amuro was the sole survivor and witnessed the blood bath from beneath a bed as Speck strangled, stabbed, and slashed his way through the tenement.</p><p>When asked about her recovery she replied that there was no counseling and that she sustained herself by working hard as a nurse. To her, nursing was not a means to an end. Nursing was the end itself. She took care of others and was grateful for her 1966 salary of about $4.00 an hour.<br /></p><p><br /></p><br /><p><br /></p><p></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com5tag:blogger.com,1999:blog-4723755846699098373.post-68828220332695892902021-10-29T18:50:00.004-07:002021-10-30T13:05:23.339-07:00O.R. Poem<p> Find me a place</p><p>where the overheads shine bright</p><p>and the hollering gives fright.</p><p>Find me a suture that closes just right</p><p>and a patient that awakes without</p><p>a pathology that gives a great fright.</p><p><br /></p><p>I remember a young scrub nurse</p><p>hiding from the world.</p><p>Find me all these things</p><p>And that is where you'll find me.</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com7tag:blogger.com,1999:blog-4723755846699098373.post-3678573951411183732021-09-09T18:38:00.001-07:002021-09-09T18:38:26.467-07:00Needle Gauge Sizing Explained<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXSjA8vUZsYl7YfOSasa6Rpnyg_L9Ra6hWZZv3u1VX022OwbWf5Jg7UjH6B_g9M_MssnwvY-oK28bJruXwoH039ij1Z5PyRizz6ri2EvlwFq1LYCgg03K4b4o-ijh7XUx6I9p8SR5KTjc/s446/unset1968mghs_0035.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="446" data-original-width="254" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXSjA8vUZsYl7YfOSasa6Rpnyg_L9Ra6hWZZv3u1VX022OwbWf5Jg7UjH6B_g9M_MssnwvY-oK28bJruXwoH039ij1Z5PyRizz6ri2EvlwFq1LYCgg03K4b4o-ijh7XUx6I9p8SR5KTjc/s320/unset1968mghs_0035.jpg" width="182" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Hmm...It's easier for a camel to pass through<br />the eye of a needle than avoid Miss Bruiser's<br />painful ministrations!<br /><br /></td></tr></tbody></table>Sizing of most medical implements made sense, gloves were measured by running a tape measure across the mid section of the hand, the measurement in inches was the glove size. Catheters were measured in Fr. and one French was equal to 1/3 mm. a 32 Fr. catheter was most definitely larger than a 26 Fr. Endotracheal tube diameters are measured in simple millimeters. Nice and straightforward for foolish folks like myself.<div><br /></div><div>Needle caliber sizing is a horse of a different color. Miss Bruiser, my favorite nursing instructor insisted that physical discomfort (pain) was required for a student nurse's proper education, so when she gave us a choice of needle size for injection practice sessions it was obviously a trick question. Her beady little eyes shifted like a pinball in play when she asked, "Now which size needle would you like me to use on your tender deltoid when I demonstrate an intramuscular injection technique, A 16ga or a 22ga?" Well a 16ga sounded like the best choice because the logical thought process would deduce that 16 is less than 22 so the needle would be of a smaller caliber and hurt less when harpooned by a towering Miss Bruiser. Well we were dead wrong and had the bloody aching arms to prove it.<br /></div><div><br /></div><div> Every nurse knows that the smaller the gauge number, the bigger the needle, but how in blue blazes did this come about? Up until the dawn of the 20th century there was no standard for needle size other than puny, medium, and jumbo. Thanks to the British wire industry things were about to change.</div><div><br /></div><div>Needle sizing is a direct descendant of ye ol' Birmingham wire gauge which was widely used as an industrial standard in merry old England. According to this standard a #1 gauge wire had a diameter of 6.26mm which was used as a starting point for the measurement of wire diameters. The number of wires that could fit in this defined area was the gauge. It's easy to see that for an area of 6 mm diameter (or there abouts) to accommodate 25 strands of wire they would have to be much, much less of a diameter than say #12 gauge to occupy the exact same area. The greater the number of wires ram rodded into the same sized area, the lesser the diameter. So that's why the higher the needle gauge, the smaller the diameter of the needle. I'll take getting harpooned with 27 gauge needle over a 16 gauge any day!</div><div><br /></div><div>As time went on, the Birmingham wire gauge was further improved and made more exacting for the sizing of medical needles by meticulously defining the steps between the different gauges, for 7-14 gauge needles the size increased by .025 mm for each larger size needle, to 19 gauge the size increased by .013mm, and lastly with the small needles size increased by .0064 mm. When you think about tiny needles, just a small decrease in gauge can make a really big difference so that's why the steps between gauges are so small.</div><div><br /></div><div>The year 1955 was an occasion for old nurses to celebrate. Roeher Products introduced the disposable Monoject syringe which allowed for a choice of needle size which was independent of the syringe. The color coding of needle sizes was born and every nurse knew a bright red needle guard signified a 25 ga needle and a blue guard meant a 21 ga. I never could figure out why a 20 ga needle and a 25 ga had the same reddish color, although the 20 guage was of a very light shade. </div><div><br /></div><div>The needle that gave every novice nurse the tremblors was not a monster 16ga, but rather the mighty 2 inch long.Imferon needle with the purple guard. I shudder to think of the misery Miss Bruiser could inflict with one of these monsters as it bounced off periosteum with a loud clunk followed by an ear splitting shriek!</div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com3tag:blogger.com,1999:blog-4723755846699098373.post-20884801986751663532021-07-06T18:42:00.002-07:002021-07-08T12:39:48.862-07:00Portrait of the Scrub Nurse As an Artist<p></p><div class="separator" style="clear: both; text-align: center;"><br /></div>Yep...I hijacked the title to this post from that great Irish literary genius, James Joyce, whose near blindness probably enhanced his writing ability by excluding extraneous stimuli. Operating rooms, on the other hand, have loads of stimuli, but they are certainly nothing to look at. The stark, tiled walls and hard unforgiving terrazo floors almost call out for beautification and just about anything aesthetically pleasing is a huge step forward.<div><br /><div>Scrub nurses have a variety of artistic media available to them right on their Mayo stand and each individual has their own style. My attempts were crude compared to some of the Rembrandt like efforts of today's youngsters. I'll give a brief account of my lame efforts and then morph into some truly beautiful work by contemporary <strike>artists</strike> scrub nurses and scrub techs.</div><div><br /></div><div>My initial artistic endeavors involved cutting various designs in my sharps bag which was really nothing more than a plain old waxed brown paper container. A straight Mayo scissors was the perfect cutting tool and I began with profiles of hearts on the sides of the bag. After all, any operating room could use a little more love.</div><div><br /></div><div> As my skills advanced, flowing scalloped edges inspired by the Rococo school of art adorned the top of my sharps bag. Ratcheting a needle out of my driver and dumping it in the sharps bag had a new found feeling of artistic fulfillment as I watched it drop past those lovely scallops. Simple pleasures for simple minds.<p></p></div></div><div>In the 1970's the hottest new innovation in surgical draping was a material called Vi Drape which was nothing more than a sheet of polyurethane with an adhesive backing. After prepping, a sheet of Vi Drape was applied to the skin and the surgeon made his incision smack dab through the Vi Drape. No cutting corners here! The idea was to isolate the skin from the surgical site to prevent infection. Vi Drape also provided a sterile platform for plopping an organ down on it without fear of contamination.</div><div><br /></div><div>Before the skin sutures were thrown in place, the Vi Drape was pealed off and unceremoniously tossed in the ever ready kick bucket. While removing a used Vi Drape from the bucket, I noticed how the overhead lights illuminated it, creating a stunning design. The center of the drape that had been incised glowed like a twinkling star and it was surrounded by a lovely pinkish glow thanks to the retained Zepharin prep solution. Pink tinged Zepharin was certainly more pleasant to look at than the yucky brown Betadine prep which is so ubiquitous today. The speckling added by blood droplets and minitissue chunks highlighted the brilliant center of the design.</div><div><br /></div><div>How could I display this masterpiece? The answer was no further than an unused light box used to view X-Rays in our break room. I archivally preserved my masterpiece by sealing it in unused Vi Drape and secured it to the light box. There was mixed reaction from my fellow nurses. Some loved it while others thought I was nuts. Art is supposed to get folks talking and asking questions so I fulfilled my purpose.</div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy42drOe3dppjJLYsQ7uw9eE1fTuqwuvNhSwkGQjMW6wC4t8i1-Y7RtysXAxuipB6vLeUBi8ZhhRmEjEWMJotV7r6bhvLorr787_UpBezsXlcoZUQCCayDdy7sMr_UEMVUJxwVYjkRFdE/s549/Web+capture_3-7-2021_212458_www.instagram.com.jpeg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="549" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy42drOe3dppjJLYsQ7uw9eE1fTuqwuvNhSwkGQjMW6wC4t8i1-Y7RtysXAxuipB6vLeUBi8ZhhRmEjEWMJotV7r6bhvLorr787_UpBezsXlcoZUQCCayDdy7sMr_UEMVUJxwVYjkRFdE/s320/Web+capture_3-7-2021_212458_www.instagram.com.jpeg" width="320" /></a></div>Now for the good stuff. Orthopedic surgery provides whippersnapperns with a great media for sculpture, namely bone cement. Marjorie RN at bloodgutsandcoffee on Instagram has some really great work displayed on her posts. The sample on the left has even been enhanced with what is apparently Methylene blue and a surgical marking pen. How cool is that.</div><div><br /></div><div>Orthopedic surgery also provides for brief "time snacks" while portable X-rays are taken. What a perfect time for artistic endeavors. Every moment of pseudo leisure can be put to good use in the OR. Sculpting with bone cement is surely lots more fun than gazing at that yucky blood/bone chip slurry reposing at your feet.</div><div><br /></div><div>When I was a youngster, surgical marking tools were limited to a tooth pick and a medicine glass filled with methylene blue. To mark an area the tooth pick was dipped in the dye and dabbed in place, a crude method which did not lend itself to intricate designs or sketches.</div><div><br /></div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAyl9n6LI9FkV8L6imWPVi-R7cYsJ1-VMp_yrs__LoxisrHDuodTUPWTtCWeGxMBh9bw0tD4uQF5beroqPYfz0XvXyrLQvhDZFLdZlueuulkTHD7ubRccFa7bFnNgVexRdPUhFEB3Gzc4/s509/Web+capture_5-7-2021_212210_www.instagram.com.jpeg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="406" data-original-width="509" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAyl9n6LI9FkV8L6imWPVi-R7cYsJ1-VMp_yrs__LoxisrHDuodTUPWTtCWeGxMBh9bw0tD4uQF5beroqPYfz0XvXyrLQvhDZFLdZlueuulkTHD7ubRccFa7bFnNgVexRdPUhFEB3Gzc4/w400-h319/Web+capture_5-7-2021_212210_www.instagram.com.jpeg" width="400" /></a>Today, it's a different story. There are all sorts of surgical marking tools that are not only useful in marking patient's skin, but also function great as a means of artistic expression. The canvas is a surgical towel or mayo stand cover. Surgidoodle on Instagram has some of the most intricate and lovely designs I have ever seen. This "circle of time" is one of my favorites and the way the tips of a pair of Babcock clamps point directly to the serpents head is really spooky. Maybe someone is about to snag that serpent in the jaws of their Babcock and free that omniscient eye lurking in the center. Who knows!</div><div><br /></div><br /><div>Surgidoodle also has a simply elegant work on her Instagram page titled SHARK ATTACK. You won't get any of that artsy fartsy sillyspeak from me on this magnificent work. It's simply beyond description. The contrast between the stark line drawing of the attack with the severed lower extremity and the ambiguity of the bloody mottled background make us consider the complexly entangled lives we lead in the OR. Heavy stuff, indeed.</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidkS3h1T6fPkcoz2JWeztpyfiXvR7DGd_RcdVy8uNqWJWVDWMRHNRWHteLHx7aMpZtPbYhYxrLK3T3EmNmm4UXyW-qRqhEvme1QRksccScM3YTtcmgIhXQATbsRIaFpFtX24dbB68Rdk0/s612/Web+capture_6-7-2021_21832_www.instagram.com.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="534" data-original-width="612" height="558" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidkS3h1T6fPkcoz2JWeztpyfiXvR7DGd_RcdVy8uNqWJWVDWMRHNRWHteLHx7aMpZtPbYhYxrLK3T3EmNmm4UXyW-qRqhEvme1QRksccScM3YTtcmgIhXQATbsRIaFpFtX24dbB68Rdk0/w640-h558/Web+capture_6-7-2021_21832_www.instagram.com.jpeg" width="640" /></a></div><br /><div>Shark Attack has all the elements of a quintessential work of fine art: A life altering event frozen in time, the sometimes random element of trauma infliction, how trauma dissociation is based on evolutionary survival behavior, how invalidated trauma generates silent internal screams, and an inquiry of the survivability of traumatic injury. The assorted components cohere into an elegant whole that transcends the harsh, unforgiving environment of the tiled temple. Compared with the wan, self involved art (I'm thinking of the Andy Warhol Museum here in Pittsburgh,) which strain for undeserved and unearned profundity, Shark Attack is in a class by itself!</div><div><br /></div><div><br /></div>If I have piqued your interest in operating room artists here is a listing of some of the ones I enjoy on Instagram.<div><br /></div><div><u>ortho_artistry</u> features some very nice bone cement sculpture work</div><div><br /></div><div><u>operatingroomart</u> shows us some lovely abstract images created by a urologist with a cystoscope and gel. Absolutely more colorful than a meatotomy!</div><div><br /></div><div><u>surgeryboxcartoons</u> shows what can be done with a surgical head covering container.</div><div><br /></div><div>And of course surgidoodle which is my all time favorite. Thanks for inspiring me to finally get around to posting something. <br /><div><br /><div class="separator" style="clear: both; text-align: center;">.</div></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com2tag:blogger.com,1999:blog-4723755846699098373.post-56457810743275011992021-06-15T18:41:00.005-07:002021-06-15T18:43:39.269-07:00Downey V.A. Hospital Signage<p>Dr. Scott Mastores is a graduate of Chicago Medical School which was constructed on the Downey VA Hospital grounds shortly after I quit working there. Thankfully, he rescued this sign from the trash and was kind enough to Email it to me to share with all those interested in Downey VA hospital.</p><p>There were lots of interesting signs at Downey and this one was on prominent display in the lobby of most of the buildings. I don't think many of the patients bothered to read them and enforcement was lax. Most of the nurses at Downey would much rather have patients lying on the floor than fighting on the wards.</p><p>Just about every ward had a pool table and a sign that stated throwing pool balls was prohibited. I broke up an unusually nasty altercation where two patients were bayonetting each other with pool cues and was promptly advised there was no signage prohibiting this activity. "If we can't throw poll balls at one another, what are we supposed to do?" was their response.<br /> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuhBrfBAOYJNsqYbbgX1LL4Lyk23r0DpMJrxzAzYDjhW7aQBlxXXUFd4iGn1CHVzKKUAIAm8xdmZQZGOP_H8i1zdUcswycS7vEMFV8vCPlZRY2wEQtgbRKnaqRcBO-IvaW4rjKLsfasv0/s2048/image_123923953.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuhBrfBAOYJNsqYbbgX1LL4Lyk23r0DpMJrxzAzYDjhW7aQBlxXXUFd4iGn1CHVzKKUAIAm8xdmZQZGOP_H8i1zdUcswycS7vEMFV8vCPlZRY2wEQtgbRKnaqRcBO-IvaW4rjKLsfasv0/w480-h640/image_123923953.JPG" width="480" /></a></div><p></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com3tag:blogger.com,1999:blog-4723755846699098373.post-72952885705246723852021-06-05T12:56:00.002-07:002021-06-05T12:56:36.505-07:00Boo Hoo<p> Lots of views, but no comments and I'm stuck in a terrible brain freeze. I'm open to any suggestions for a post. Thought about an updated nursing awards post if I can crawl out of this cognitive abyss!</p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com15tag:blogger.com,1999:blog-4723755846699098373.post-47535843941435009692021-05-22T13:00:00.005-07:002021-05-22T18:12:07.450-07:00Stick 'Em Up<p> </p><div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNO4BEIX-R6zYBJE7Ex3a6yFyTVcEcZpx1UlBzCMtQOemzAS2yWS-82vbPXwMdw_ShBfQRSf94aDPCWA0iTU8teibQMuMWfXkNL3tWsNJm9inlD-uW0FCIjTGpSbx9ECh0EZMTBj4-JJs/s488/nbg_ppl_00080.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="488" data-original-width="465" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNO4BEIX-R6zYBJE7Ex3a6yFyTVcEcZpx1UlBzCMtQOemzAS2yWS-82vbPXwMdw_ShBfQRSf94aDPCWA0iTU8teibQMuMWfXkNL3tWsNJm9inlD-uW0FCIjTGpSbx9ECh0EZMTBj4-JJs/w381-h400/nbg_ppl_00080.jpg" width="381" /></a></div> "That's the last Bicillin shot you're ever going to give!"<p></p>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0tag:blogger.com,1999:blog-4723755846699098373.post-59347563983652511102021-05-10T18:45:00.003-07:002022-11-06T15:26:12.496-08:00Student Nurses Learn to Smoke Cigarettes<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKfOGiVBKdACVQ4BUmCbKU4QT-4-TSX9xbqnickCEu78hZPOOkyI2SmL2sp3b4O4saXM3N_2gj-wsQM5-VRFhj3NfzJJXmEKJMmUF0gnXUdSZxEu4wmSVZCNQUvqZBm-GvylvfssmimM4/s686/resolver+%25281%2529.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="527" data-original-width="686" height="308" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKfOGiVBKdACVQ4BUmCbKU4QT-4-TSX9xbqnickCEu78hZPOOkyI2SmL2sp3b4O4saXM3N_2gj-wsQM5-VRFhj3NfzJJXmEKJMmUF0gnXUdSZxEu4wmSVZCNQUvqZBm-GvylvfssmimM4/w400-h308/resolver+%25281%2529.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">"All right it's time to break up into groups of two. The smokers will demonstrate<br /> to the non-smokers how to light up and inhale a cigarette. Return demonstration<br />is required and I don't want to hear any of that gagging or coughing!"<br /><br /></td></tr></tbody></table><br /> Every hospital based nursing school had a class motto. In my school where Miss Bruiser, my favorite instructor presided, the old adage was; <i>A journey of a thousand miles begins with a single step. </i>Initially, we thought this slogan referred to breaking down an arduous accomplishment into simple steps to achieve our final goal of receiving that coveted pin, but after nearly three brow beating years and constant harassment our assessment shifted. A thousand miles was along way from home and diploma nursing education transported us to a bizarre new world with strange new rules and customs. Professional adjustments was our very last class and we were going to learn how to conduct ourselves as nurses in this strange new land.<p></p><div>Miss Bruiser, regal and pompous like a queen, strutted around the classroom with her cap serving as a crown. Her edicts were delivered sternly in the same tone one uses to discipline an unruly child or train a dog. It almost felt like she was deploying little bombs in the back of our heads, set to detonate sometime in our future nursing life.</div><div><br /></div><div>Miss Bruiser harshly intoned, "The first order of business is going to be the use of tobacco products. Every nurse should learn how to smoke cigarettes in order to connect and relate to patients, especially on the psych wards where it's an absolute must and I don't want to hear any of your lamentations or sniveling. If the smoke bothers your throat do what I do, smoke menthols or don't inhale!" ( Hmm...I wondered if Bill Clinton was a nurse in a previous life, that "don't inhale" business sounds all too familiar.)<br /></div><div><br /></div><div>The finer points of cigarette smoking included the proper use of ash trays and cautions about letting the ash get too long. Never aggressively flick an ash or use a cigarette to gesture which might give the wrong impression. I never could figure out the rationale for those two rules, but like many other things, there were many mysteries in nursing. The rule about holding a cigarette between the index and second finger made sense. In Chicago only gangsters held their cigarettes between the thumb and index finger.</div><div><br /></div><div>The opening lecture about smoking set the tone for the entire course. It didn't much matter what your personal feelings or wants entailed, you were going to be a nurse and it was way too late to question the rules. We got what we set out to get and that was the only thing that mattered.</div><div><br /></div><div>Money was always a hot button issue in diploma nursing programs as alluded to in a previous post, we were not even allowed to carry money because it simply was not needed. The school met all your needs from food, housing, books, and uniforms.</div><div><br /></div><div> The third rail in any nursing job interview was inquiring about salary or compensation. Instant death to anyone foolish enough to ask. Nursing was not meant to provide practitioners with financial stability, but you won't ever be broke and you do eventually learn to navigate desperate situations with your pride intact.</div><div><br /></div><div> Asking for or charging other nurses money for just about anything will rot your pride. I think that's what makes me cringe when I hear whippersnapperns asking for payment for online education or commercial products. I realize we are in a brave new age but I'll never get used to nurses asking other nurses for financial compensation. It makes me very anxious because it makes me feel like bad things are coming and I can almost hear Miss Bruiser's howls in the background.<br /></div><div><br /></div><div>Working at a charity hospital highlights the unfairness in the world and careers that earn a good bit of money were seen to exacerbate the inequalities in society. Despite the financial precarity of a nurses salary there was a unique kind of ecstasy in helping those in dire straits. The overly productive lifestyle of folks with money begins to appear pointless. So instead of a class on retirement planning or investing we were conditioned to live with very little.</div><div><br /></div><div>Although diploma nursing school did have a cognitive constipating curriculum, there were life lessons if you could see past the smoke screen. Miss Bruiser's notion of sacrificing every thing for patient care was not sustainable. A nurse's notion of self care has to extend beyond a break for a Coke and a smoke. I think whippersnapperns have a much more realistic notion when it comes to self care.<br /></div><div><br /></div><div>The lesson that really stuck with me was that it really doesn't require much money to generate happiness and well being. Some of my happiest days were spent in a crumbling third floor apartment with my Raleigh bicycle parked in the hall.</div><div><br /></div><div>Lucky for me, I really never got the hang of that smoking business. If I had been a successful smoker, it's unlikely I would have survived to become an OldfoolRN!<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiweWSjLKVNVLPrTf0SZDV0SwUdqKqxNB_xVRo0KWV307i26m2bIrItP8BAJd-X1AkdIJdBiM2XT1SfBJvmVpIMxzup8HWbTznLxVa-hFTDMZFda-SYyXDJ2Qm07ZqQ12p7MfXjZ7MkU5zYBKCaTYksMLEds9r2QTRO79LfvI7rW9a5oLrMDR2z2I8G/s3176/nlm_nlmuid-101610910-img.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="3176" data-original-width="1991" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiweWSjLKVNVLPrTf0SZDV0SwUdqKqxNB_xVRo0KWV307i26m2bIrItP8BAJd-X1AkdIJdBiM2XT1SfBJvmVpIMxzup8HWbTznLxVa-hFTDMZFda-SYyXDJ2Qm07ZqQ12p7MfXjZ7MkU5zYBKCaTYksMLEds9r2QTRO79LfvI7rW9a5oLrMDR2z2I8G/s320/nlm_nlmuid-101610910-img.jpg" width="201" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Practice makes perfect!</td></tr></tbody></table><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div>Oldfoolrnhttp://www.blogger.com/profile/01747485143127099085noreply@blogger.com0