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

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

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

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

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

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

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

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

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

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

Custom Made Signage by Nurses

 Hospitals are infested with signage developed by office sitting busy bodies promoting policy, giving direction, or threatening grave consequences for those with the nerve to be non-compliant with their all important edicts. Signs have authority and grab your attention. Who  in the world is going to fool with a red bag tagged with the warning: CHEMO THERAPEUTIC INFECTOUS WASTE? It's enough to scare the daylights out of a Pope.

Bedside nurses  put other's   needs before their own  because they are wired differently at the factory as compared to business minded hospital big shots. Information flows down from the top with a remarkable efficiency, but enlightenment gained in the trenches stays there. Hand made signs posted by harried nurses are an attempt  to break this communication barrier. It's difficult and dangerous to transition a one way street to bidirectional traffic, but that doesn't stop sign maker nurses from trying.

Nurses can be their own worst enemy. In nursing school we had a bulletin board for posting NLN test results that we called the wailing wall. Instructors were also known to publicly humiliate their students by posting signage advertising particularly egregious clinical  blunders. One memorable sign announced with great fanfare that "Gwen had attempted to irrigate her patient's Foley catheter with a TB syringe." That was cringe worthy because the syringe was too small by a factor of 100cc. or more.

Step down units are typically located adjacent to critical care units and the staff members get along about as well as cats and dogs. Step down nurses think ICU nurses are cowboy or girl know-it-alls with overblown egos and are eager to put these hot shots in their rightful place. I noticed a huge poster plastered on the ICU locker room door stating "THIS CAME OUT OF ICU." It was a double heparin locked IV catheter. An ICU nurse was probably doing a gazillion things at once and failed to notice the patients IV was capped with a heparin lock and hep locked the needle previously inserted. I figured out a scheme to convert the sign from an admonishment to amusement by inserting several more needles and hep locking  them in place so there was a series of hep locks about a foot long. A dose of good natured badinage helps improve relations among feuding groups of nurses.

UPMC, the health care behemoth here in Pittsburgh has power. When they acquired Montefiore Hospital which was built into a hillside ala Pennsylvania bank barn style they changed the names of the institution's floors. What nerve!  The hospital was entered from the summit of the hill on a floor called "Main." A, B, and C floors were underground and the floor above main was the first floor. UPMC renamed "C" level as the  first floor and the other units followed in numerical sequence. A series of lengthy, confounding memos and signage flowed from the corporate geniuses at UPMC explaining the new nomenclature. Leave it to a nurse to explain things in simple, straight forward language with her sign explaining, "MAIN HAS MOVED TO 4TH FLOOR AND FIRST FLOOR HAS MOVED TO THE 5TH FLOOR." It may have sounded whacky, but everyone knew what she meant.

Who made this sign? Not me!

Coffee is an essential on any nursing unit and anything impeding it's consumption must be dealt with. Our neuro ICU coffee pot shared electrical outlets with a vending machine and somehow the coffe maker was often unplugged. A nurse attached a sign to the electrical cord running from the coffee maker: "DO NOT UNPLUG-VITAL LIFE SUPPORT EQUIPMENT" Folks honored the official looking sign and we always had hot coffee.

Nurses of The Greatest Generation

Miss Bruiser, a proud member of The Greatest Generation

My indoctrination , if you could call it that, to the world of nursing  came under the tutelage of a rough and tough assemblage of gallant geezers from the heart of The Greatest Generation. These nurses were forged in a cauldron of  devastating diseases, arrogant paternalistic physicians, and a life of abject poverty where it was a virtue to eschew any accumulation of material goods.

Battle scared nurses like these aroused paradoxical emotions among lowly student nurses. We held them up as the ultimate in role models, yet we wanted to be nothing like them in their surly approach to nursing care and life in general. Their level of dedication was without question, but their demeanor left much to be desired as they were a frightening assemblage of care givers.

These  nurses had sacrificed and paid the price on a daily basis. Trivial pastimes and activities for amusement were unheard of. Today's notion of self care for nurses would have ignited a hearty belly laugh from these nurses and a stern rebuke, "Spend more time with your patients and stop thinking about yourself. It's not about you!!" The notion that caring for others required caring for yourself was the ultimate in tomfoolery.

These nurses were masters at giving up personal comfort for what bordered on self  torture. Sacrificing ease for discomfort to benefit patients was second nature to this intense hard core group. Their footwear, Red Cross shoes, were metatarsal unfriendly to say the least. Remember that Pulitzer Prize photo of the nurse kissing the sailor at the conclusion of WWII?  Those were bunion busting Red Cross Shoes and a podiatrist's nightmare. Those heavy, white starched uniforms looked very official, but on those wards that were brick oven hot, cotton clothing acted like a sweatsuit. I don't know how they functioned with pools of sweat dripping from overheated extremities.

Vintage diploma nursing schools were ruled by a set of rigid authoritarian regulations. Marriage was prohibited any time during those tortuous 3 years and pregnancy meant an automatic expulsion. One of my fellow students had a fascinating tale about her mother's determination to graduate from nurse's training. Mary's Mom was a large-scale sized person so a few extra pounds on her was like an extra suitcase on a Boeing 747; not something noticeable. Near the end of the nursing program she became pregnant with Mary. She delivered the baby at nearby Ravenswood Hospital a couple of weeks prior to graduation and was present for the final awarding of her nursing pin with not a soul the wiser. Mary was in the graduation audience cradled in her grandmother's arms.

Nurses from this era had a sense of consecratedness to their profession where persistence was one of the primary themes. These folks had a never say die mindset and persistent nurses never quit when it gets rough, when they lose, or when it hurts. I've known older nurses to continue working despite disabling arthritis and physical disability that would hobble just about anyone else.

Older nurses were highly skeptical of anything new. I remember the outcry over the installation of  nurse call lights when wards were being divided to semi-private rooms. These nurses thought it was ridiculous for a patient to summon a nurse by pressing a button. The nurse should always be close to the bedside. Team nursing, disposable needles, anything made of plastic,  and  swadged, atraumatic sutures were other useless new fangled ideas. Why tinker with something that worked for decades.

It's a good thing that Press Ganey patient surveys were unheard of  in this era. Old nurses were in charge and always  knew what was best for their patients. Any health problem that could be construed as self-inflicted drew a particularly tough, unsympathetic rebuke. As a student caring for an alcoholic patient with draining wounds on his legs, I was enlightened by one of the older nurses, "That's all the filth and evil leaving his body," Rita knowingly advised. I was belittled when coming to the patient's defense. Clearly, these nurses were not ones to tolerate dissent.

Fun in The Sun at Diploma Nursing Schools

"After I sink this one, let's  visit the sun deck!"

Old time 3 year diploma nursing schools lacked the recreational amenities  of modern learning institutions, but they did provide some outlets for brow beaten,  harried students to unwind. The notion of fresh air and sunshine as a curative modality was a core value of the traditional Nightengale mindset; hospitals had solariums and almost every nursing school had a sundeck.

As sundecks were the common denominator at diploma nursing schools, most hospitals had at least one other diversional activity. Cook County School of Nursing had a magnificent indoor swimming pool. After a brief journey through dingy, rat infested catacombs an elegant facility complete with Romanesque columns emerged. The lavish pool was a  unique oasis oddly situated in the midst of a dingy, depressing, medically underserved environment of intractable social problems and abject poverty. A true diamond in the rough.

 Our hospital had a lowly pool table located adjacent to the sun deck entrance and students often picked up a cue and attacked the racked balls before sunning themselves. Nearby Ravenswood hospital had dual purpose sundeck that also served as a badminton court. Weiss Memorial Hospital had a combo shuffleboard court sundeck.

Most all sundecks in Chicago hospital nursing schools  were located on the roof of the nursing school as a concession to the cramped urban environment. The nurse's sundeck was on the roof and 4 stories off the ground at our beloved learning institution. (If you could even call it that.) The operating rooms on the seventh floor overlooked the nurse's residence sun deck and provided geezer surgeons an unobtrusive vector for ogling the scantily clad students. An amorous break from the rigors of the operating room was only three stories away and many took advantage of the opportunity.

A generous sized cedar wooden deck that occupied about a third of the roof top made up the formal deck. This structure was surrounded by a chain link fence that prominently commanded a sense of forbiddance. A few deck chairs and a large phony looking  plasticized   palm tree provided atmosphere. A tropical paradise amongst the Chicago concrete jungle seemed to be the idea.  Just toss a dime in the nearby beverage  vending machine for a can of Tab soda and stretch out on a beach chaise. Life was good.

Tropical Bliss Comes to a Chicago Nursing School

Sundeck activities, like everything else, were governed by the rules set forth in every student nurse's bible, the official student hand book. Here is what the powers at be had to say:
A sundeck is provided for the convenience and pleasure of the students. It is open from 8AM to sunset. School linens, pillows and blankets are not to be taken out on the sundeck. Radios are permitted on the sun porch if played softly. Suitable chairs, chaise lounges, and mats are provided and must be returned after each use. Some type of beach coat or covering must be worn to and from the sundeck.

Like Baptists, diploma nursing schools firmly believed in total immersion, not in water, but in the hospital milieu.  I think any oppressed minority cultivates  a latent rebellious streak and student nurses were no exception. The sundeck overlooked the faculty entrance to the hallowed halls of the lecture auditorium where bitter, hardened, old instructors put their students through their paces. After a severe ear beating on the clinical unit for a pillow oriented the wrong way  toward the door, one of the students, Rose, hatched a diabolical plot for revenge. An Asepto syringe and a bath basin created a sluice of water that cascaded over the sundeck just as the formidable Miss Bruiser made an appearance. She was an aficionado of flowing capes, but nevertheless received a generous soaking

Soon after Miss Bruiser's unfortunate encounter with the cascading fountain of water, a warning sign was posted; Any  student caught propelling any substance off the sun deck will be referred to the student disciplinary committee for possible expulsion. As young Rose loaded her Asepto for another aquatic volley she replied with a snicker, "They have to catch us first!"

Student Nurses Misappropriate Birth Certificates to Imbibe

Vintage diploma nursing schools had rigid, authoritarian  rules for just about everything  that could be construed as fun. From restrictions on outside visitors, especially men, to strict study hours, all recreational outlets were meticulously managed with onerous regulation. The rules regarding alcoholic beverages were especially strict and came from the hallowed chambers of  The Hospital  Board of Trustees. This mysterious and often cited governing body was a force to be reckoned with because just one measly slip up of their regulations could get you expelled from the nursing program.

According to the esteemed board, alcohol was the ultimate in forbidden fruit, especially for stressed out and underaged nursing students. The notion that imbibing in the magical elixir of alcoholic drink was wrong, made it all the more appealing. Diploma nursing students were in the same boat as Eve in the Garden of Eden.

By the time nursing specialties: pediatrics, psych, and obstetrics, rolled around, nursing students were feeling the pressure of their chosen vocation. I was going to say chosen profession, but we were brain washed into submission and nobody really believed we were worthy of such a lofty title. I'm just a nurse was our mantra. Doctors were professional-nurses were not.

All nursing specialties were difficult and stressful. Cures for seriously ill children were few and far between. Leukemia of any variety was a death sentence. Our clinical psych experience was on the back ward of a state hospital and it was your lucky day if your patient wasn't homicidal. I don't know which was more trying on your soul,  psych or pediatrics. It was a toss-up.

Obstetrics was different, especially post partum where the exuberance of young mothers was uplifting. Our time in OB was rotated in monthly intervals through delivery room, nursery, and post partum. Everyone had their particular favorite, but delivery room duty was the highlight of just about any young student  nurse's  training. The miracle of birth was something that stayed with you and served as an antidote to all the pain and suffering in the rest of the hospital. Birth and death were the ultimate Yin/Yang experience.

The delivery room had another up side. Stashed right next to vials of silver nitrate which was used prophylactically in  babies' eyes to prevent blindness from contact with gonorrhea was a stack of blank birth certificates.

The unwritten rule was that each student nurse was entitled to one blank birth certificate at the conclusion of their delivery room rotation. Students treasured documents from their various specialty rotations and I still have a plundered birth certificate along with a sponge count record from the OR and a restraint and seclusion record from psych.

I first learned what could be done with a blank birth certificate from one of my fellow students who had been released from Cook County School of Nursing as being unsuited for the practice of nursing. That "unsuited" business was a catch all phrase that covered a multitude of sins and was a step up from academic failure because some of these students were able to transfer to another diploma nursing program after "maturing." Transfer students were a valuable resource when it came to surviving nursing school because they knew many of subtle ins and outs of getting through the madness of three years of torture.

Light fingered nursing students knew exactly what to do with a poached birth certificate. "All you have to do is fill in your own name with a birthdate of more than 21 years ago and the document becomes your ticket to freedom from the evil clutches of the sanctimonious "dry" hospital environs," explained one of these wise transfer students. Time to unleash the libations.

Barkeepers found the neighborhoods surrounding hospitals as fertile ground for their trade. There was no shortage of stressed out workers that had pay checks to support their bar tabs. These taverns often had clever names like "Recovery Room" or "Barborygmi." The bar of choice near our hospital was "Ratzos" and the barkeep would just wink and pour when presented with a birth certificate with freshly inked infant footprints. This little charade had been going on for a very long time and was one of the dirty little secrets of old school diploma schools. Cheers! as Sue  would say.

How Hospitals Transitioned From Chairity Care to A Corporate Cash In Culture

The land of the free and the home of the brave is home to some  the most expensive health care in the known universe. What the heck happened? The last I remember,  the  rate for nursing, room, and dietary in a big inner city hospital was 68 bucks per day. The charge was known as the hospital NRD fee and it covered just about everything except for OR fees and pharmaceuticals which were dirt cheap.  A visit to the ER was 28 bucks if you had it and no patient was ever out of network or even asked about insurance.

 Hospital superintendents were paid slightly more than nurses and there were no big bonuses for anyone. We were all in the same boat and everyone knew and respected frugality. This is my anecdotal account of what happened during the transition to the current cash-in culture of today's healthcare. One caveat, these notions have been filtered through what's left of an ancient nervous system that remembers old school nurses who never expected to own much of anything and lots of MDs were content with an apartment.

It's easy to rattle of a list of culprits in the stratospheric rise of healthcare cost. Entrepreneurially motivated physicians and nurses wth the notion that I worked hard and deserve bountiful financial compensation for my work is a part of the story. Patient care in of itself was the old school compensation and material deprivation produced a sense of solidarity among nurses with everyone looking out for one another.

Old nurses like myself really had it easy compared to the all for one, and one for all whippersnapperns of today when it comes to salary. Our basic needs were met without worry and there were no school loans or financial demands. If we needed medical care any MD would gladly see us as a professional courtesy and if a hospitalization was required, our diploma school had a private "alumni room" for our exclusive use. It was the only room in the hospital with genuine Karastan carpeting. Nurses lived the good life without money changing hands. It's no wonder we affectionately referred to our hospital as "Mother."

Explosive growth of technology and electronic record keeping consumes lots of dollars. So do mindless Press Gainey surveys. Old school physicians would argue until they were blue in the face that patients are not qualified to make judgments about the quality of their care. I can see their point. Some of the very best surgeons I worked with were not very touchy-feely, and that's putting it nicely. Dr. Slambow would visit post-op patients with part of his breakfast and/or lunch spilled on his tie and shirt. I can see why folks would question the credibility of a surgeon wearing his breakfast and lunch, but he was one of the best when it came to minimizing post-op complications.

In the late 1970s my humble school of nursing was closed down for good after being in existence for almost 100 years. The building functioned as an oncology clinic for a couple of years and was then razed for the construction of a multi-level, monstrous parking garage. Fancy hospital parking facilities are given short shrift when considering how corporate interests made health care such an expensive commodity. This is where the rubber meets the road (or parking garage) in my woe filled tale. Parking garages are at the root of the problem.

Parking garages became the welcoming mat for hoards of greedy go-getters

Very few nurses owned cars when I was toiling at the bedside. We made do with the CTA, bicycles or good old fashioned shoe leather, those Clinic shoes were made for walking, It's interesting to note that our nursing school was way ahead of the curve when it came to alternative transportation. The first object to greet someone approaching the school was a massive bike rack, usually at least half full. There were no worries about locking your bike. Who would even think of stealing a nurse's bike?

Physicians and the fortunate few that owned autos found ample space on the street or small unregulated surface lots. Patients arrived at the hospital by taxi, bus, or walk-ins. There was no EMS, and trauma patients frequently arrived in the back of police cars or paddy wagons. Chicago police operated unique,  three wheeler Harley-Davidson motorcycles  which could be ridden just about anywhere. I vividly recall a drowning victim from Montrose Beach being hauled up to the ER secured to the back of a police officer's tricycle motorcycle. The officer even went so far as to suggest the road bumps jostled the water out of the victims airway. The patient survived with quite a story to tell. Maybe the cop had a point.

Hospital parking garages dramatically demonstrate the ridiculous profusion of administrative busy bodies, clerical, and unnecessary hucksters attempting to sell everything from pharmaceuticals to medical equipment. Visit just about any hospital parking facility on a Sunday morning to observe first hand how few workers are  really necessary to take care of patients and it's not because administrative big shots and pharmaceutical representatives are attending church. The Sunday morning deserted parking garage syndrome is even more acute at government agencies such as VA Hospitals.

Hospital parking garages are like a beacon to pharmaceutical hucksters. In the old days drug reps were a non-entity. No one needed to sell penicillin because it really did kill strep and everyone knew it. Much of drug pricing today is done with blatant extortion. A marketer of Zyprexa might claim that his drug will negate the necessity of long term hospitalization saving untold tens of thousands of dollars, hence,  his product is worth a ridiculous charge.

Epinephrine was dirt cheap. Everyone  knows what Mylan's Heather Bresch did with exorbitant charges for that "lifesaving" drug. I betcha if drug reps had to ride a bicycle to hospitals they would be few and far between.

Parking garages and the influx of money seeking hucksters changed how doctors and nurses thought about their patients. Money changing hands at every corner of the hospital amidst a bean counter culture changed who people were. Mega bucks doled out in bonuses to administrative big shots who never helped anyone except for themselves became the rule. It was so  much better when all I had was a Raleigh Super Course bike to ride to work and to heck with all those monstrous parking garages.

The New Nurse - circa 1965

Many thanks to Sue from Australia for discovering this vintage classic  of yesteryear's nursing practices.  The signing of papers before entering diploma school really brought back memories. We had to agree to several articles before entering school: Learn 4 pages of medical terminology before the first day of class, follow all rules in the student handbook, and be available to work any shift.

Those open casement windows reminded me of hospital renovations in the  1970s at our beloved institution of training. Old wooden double hung windows were replaced with inward tilting aluminum  casements and older nurses had a fit. It was a dirty little secret that nurses emptied urinals and even Gomco suction bottles out those spacious old windows. The inward tilt of the casements made the act of hurling excrements over board much more difficult.  I wrote a post about this disgusting practice and was careful to give open windows a wide berth when walking outside.
https://oldfoolrn.blogspot.com/2016/04/look-out-below.html

Thanks again Sue, for this incredible time capsule of old school nursing.

Spilling the Beans on Vintage Hospital Cafeterias

Lots of folks have bitter complaints about hospital cafeteria food.  Not me!  I actually enjoyed eating in the ultimate of institutional dining settings. Student  nurses had unlimited access to this crude, but very satisfying  sustenance  via  monthly issued meal ticket books. One day my clinical work was interrupted by that dreaded summons. "Report immediately to the nursing  director's office."  I was soon ushered into her inner sanctum by her assistant who was an authentic nurse with cap and pin; there were no nattily dressed executive assistants with perfectly coiffured  hairdos  for old school nurse executives.  I was somewhat  relieved by her cheerful demeanor, "Fool, the girls  (her generic term for all student nurses except for me. Male students threw her for a loop) have told me how much you enjoy the cafeteria meals and I wanted to give you extra meal ticket books." I stammered and stuttered a timid "thank-you," and slithered out dreaming of those perfectly round machine stamped salisbury steakette  patties. I was fascinated by the way grease gravy squirted out of them and glistened in the overhead florescent lights  when pressure was applied with a fork. Fine dining in all it's stomach gurgling  glory.

The Sisyphean task of tendering expeditious food service to intermittent parades of time pressured hospital personnel gave way to many unique innovations.  Fiberglass trays were easily propelled along shiny chrome runners that minimized friction as hungry diners made their selections. Just as ceramic tile was the defining element to the operating rooms, chrome was the underlying theme to old school hospital cafeterias. The shiny stuff was just about everywhere from the food displays to borders on any horizontal surface. Even the Sweeda cash register was chrome.

 A small army of colorful characters on the supply side of the chow line could cut a gigantic sheet cake into perfect 3 inch square pieces or whip up a massive vat of our favorite desert , Whip N' Chill in the blink of an eye. I don't recall the flavor of my favorite whipped desert but it was  red in color. That  food dye would leave a permanent stain so be careful with that white uniform.

Just about any standing kettle of soup or chili would acquire a 1 inch thick layer of gooey grease that rose to the top. These underpaid but well meaning food service workers had bulging forearms from the near constant stirring motion necessary to keep the grease in suspension.

In the OR all of our cases ended in an ectomy and in the cafeteria all the meat product entrees ended in the suffix ette. There was my favorite pork chopette, steakette,  hamcheesette, and last. but not least chicken croquette. None of today's  pretentious  light and fit, locally sourced artisanal food here. Artificial flavors and texture enhancers were embraced as a great space age wonder. Those clever scientists were hard at work making our food taste better. Great work and don't spare the MSG and nitrates.

The three horsemen of addictive, pathogenic food additives were proudly displayed as the centerpiece of each table. A gigantic cylindrical dispenser of good old fashioned sugar was always front and center, tempting nurses to drown their fatigue in a hyperglycemic rush. Pepper and salt were readily available. There was nothing like dousing highly processed foodstuffs in salt for a hypertensive boost. The artery clogging fat of a pork chopette could be supplemented by that insulated mini carafe of whole cream for your coffee. Some folks liked to add a spot of whole cream to their Whip 'N Chill to give it "extra body," but I preferred mine unadulterated.

Perhaps it's time to resurrect old school hospital cafeteria food. In the mindset of today's greedy hospital corporate types foods like this are an integral component of a dynamic profit circle. Consume these  high fat, high sugar, processed food and business is booming in the diabetic clinic and cardiovascular services. Besides, I have a decades long hankering for just  one more pork choppette

Technology-The Perils of Early Adoption

When knowledge, experience and technology

fall into place concurrently amazing things happen.
Sometimes this takes time.

The latest and greatest in new technology provides contemporary hospitals health care entities with
ample fodder for advertisements and bragging rights.  Lack of experience and knowledge with technological capabilities can produce some unforeseen problems; antibiotics cure infections, but microorganisms fight back, X-ray treatments of enlarged thymus glands in children gave rise to cancer later in life, and bone marrow transplants for metastatic breast cancer were a big disappointment.

This is my personal tale of an encounter with a brain MRI done back in the good old days of the 1980's when these gigantic imaging machines were called NMRI-the "N" was short for nuclear. The neuro radiologists of today were likely in Kindergarten and ordinary run-of-the-mill radiologists interpreted these vintage scans.

After a fusillade of neuro problems including confusion, right upper extremity weakness, and visual field distortions I had one of those new fangled NMRI imaging studies performed. While I was reclined in the tight confines of that sewer pipe of a machine, I was aware of a commotion commencing in the procedure room. Turns out mine was one of the very first NMRIs that showed significant pathology at this facility and an audience had gathered to witness the premier event. I walked into the NMRI room and left on a Gurney for an acute neuro ward-not a good sign.  Here is the radiologist's interpretation.

The striking finding is an increase in T2 signal intensity in the right occipital area and to a somewhat lesser extent in the right frontal area. Differential might include CNS lymphoma, primary demyelinating process, encephlopathic or infectious etiology less likely. Correlation with clinical findings is suggested.

Now the real fun began. Neurosurgery was consulted and felt the scan was consistent with a glioma and a stereotactic biopsy would be necessary to determine the type. Alas, this was impossible because of the unavailability of a non-ferrous stereotactic head frame. Using the standard head frame would wind up with my head plastered to the magnet like a bug on a windshield. I remember thinking about calling Jack Kevorkian to see if he could squeeze me in as the prognosis seemed more grim as time passed, but there were many more consultants waiting in the wings so let's wait and see.

Next on the parade of consultants was a neurologist whose primary area of expertise was MS, of course he concluded that MS was the diagnosis and a spinal fluid study for monoclonal antibodies would be the confirmation. The studies later proved negative for monoclonal antibodies so the diagnosis was changed from MS to "demyelination syndrome," whatever that means.

Let's consult a clinical pharmacologist to get his opinion. I was taking Azulfidine for Crohns Disease and a review of the literature suggested an encephlopathic process could be a result of taking this drug. The final diagnosis: Azulfidine induced encephalopathy. Stopping the Azulfidine made no difference in my neuro status, but jump started the Crohns, not a pleasant situation.

I slowly recovered and started backing away from follow-up appointments, figuring that whatever it was would take its course. My  neurosurgeon died about 5 years ago and I started to marvel at my survival skills having outlived him. He had given me a prognosis of 5-7 years.

So 28 years after the original excitement  a  NMRI  MRI was scheduled and it was nothing like the old time days. The machine had a wide bore and I actually missed the intimacy of being stuffed in that old sewer pipe of an NMRI machine. The technician also insisted that I use ear plugs to muffle the signal generator. I missed the booming and banging. This time sure was different.

A genuine neuro radiologist interpreted this MRI and there was none of that old school beating around the bush. This lady knew what she was looking at, no bones about it. I certainly could have benefited from her expertise 28 years ago. Here is her impression.

abnormal foci of T2 hyperintensity within the subcortical and periventricular white matter are much greater in size and number in the right cerebral hemisphere compared to the left. There is a more confluent area of abnormal T2 hyperintensity posterior to the right lateral ventricle. The asymmetrical appearance of these lesions effectively rules out classic multiple sclerosis. This MRI is indicative of an acute disseminated encephalomyelitis.

It's nice to have a definitive diagnosis even though it required a 28 year wait. Some problems cure themselves if you can wait them out. Time is the most valuable commodity and the neuro Gods have cut me a break. I'm still vertical and my foolishness remains intact but sometimes I wonder about my cognitive abilities.

Nursing Awards - Emmitt Knows Where They Belong

Proud winners of a nursing award. At least

their trophy has relevance-looks like a bath basin.

When Emmitt Smith, the hall of fame running back for the Dallas  Cowboys received the"Galloping Gobbler" award from John Madden, he knew what to do with it. No pretentious acceptance speeches or bubbly gratitude for a meaningless award.  When Emmitt thought he was off camera that pointless award was unceremoniously deposited in it's rightful place, the garbage can.

It's too bad that some nurses lack Emmitt's judgment and discretion regarding meaningless, phoney baloney awards worth their weight in wormwood. Hospitals of today often have a shrine-like  area where garish gold plaques are displayed honoring a select group of nurses. Nothing wrong with this concept if it gives recognition to deserving nurses who have honed their technical skills to help patients, but frequently the awarding entity is far removed from patient care and  has little insight into bedside nursing excellence or comforting patients. Physicians, administrative nurses (if you could even call them nurses,) insurance companies, and the nurse academic/ office sitter complex all have very minimal working knowledge of what makes a good bedside nurse. Doctors just love nurses who know their rightful place and never question orders or call them up in the middle of the night. Administrative types view nursing through the distorted lens of corporate goals and please don't get me started on office sitters of any permutation. Discretion is the better part of valor, I keep muttering to myself. Sometimes it's better to keep my foolish mouth shut.

We certainly had nothing like this when I was a nurse. Our instructors and mentors (if you could call them that) always stressed that the satisfaction of helping patients recover from injury or ailment had to come from within. If a trauma patient walked out the door or a patient's pain was relieved, you did a good job and that was your reward.  In their mind nursing was a calling and required self motivation which was also a good reason for paying nurses a poverty wage. If you are looking for good time Charley back slapping rewards or big money you are in the wrong profession.

As a public service the OFRN institute for nursing practice is going to separate the wheat from the chaff when it comes to awards for nurses. If you notice any of the following words or combination of words in the criteria or award title, its of  dubious distinction: influential, pinnacle, showcase,  emerging, distinguished, rising star, engagement, transformational, breakthrough,  paradigm, cameo, illustrious, or eminent. It's time to go above and beyond or even eschew these  nonsensical awards. It's time to take a lesson from Emmitt Smith and deposit these chucklehead awards in their rightful place.

Here are a few worthy nursing awards that have straightforward criteria and reflect nursing as it's clinically practiced, untainted from pie-in-the-sky bafflegab.

The Last Nurse Standing Award... An endurance award of sorts to the scrub nurse that can hang in there on one of those knee aching  surgeries that start before sunrise and end after sunset and I'm talking about Chicago - not the Arctic circle. My personal best is close to 8 hours on a complex trauma and that's not even worth mentioning because  my mentor Nancy went for close to 12 hours on a Whipple with complications. She deserves a standing ovation and a well deserved trip to the bathroom.

The Stink Finger Statue... Goes to the nurse who never shied away from any mess-you name the body excretion and this nurse gets down to business, sans gloves. I really admired this nurse because almost everyone has an Achilles heal when it comes to messes, mine was that gooey blood/bone chip slurry mess left on the floor of the ortho room after a long,  messy case.  Blood..no problem, bone chips..no problem, but mix them together and the resultant ooze-like  combo brought me to my knees every time. Thanks to Colleen and Gail for bailing me out on this one. You deserve this and remember to refrain from sniffing those fingers.

Venous Access King or Queen...goes to the best IV starter. Bring me your hypovolemic, phlebotic and sclerotic patient and I'll slide that angio cath in faster than you can say central line.

The Sailor Award...goes to the most fluent user of off color language. I usually avoided this one because it resulted in much childhood unpleasantness if caught uttering swearwords, but I  some how felt a sense of relief when others spouted out colorful descriptive language. Nurse  Felix deserves this award for coming up with the u;timate inclusive cuss word (sh++t,f**k.G++d**n it) all in one breath. What more can I say?

Most Likely to Cry...I always admired nurses that could do this. It's better than alcohol or drugs at diffusing sadness. The most I could come up with were a couple of stray tears, but at least I tried.

Most Kind nurse...We all know one of these. This nurse is nice to everyone and always sports an infectious smile that's even visible under a mask. As nurses age this trait seems to decline although I have met a couple of these angels in white who were well into their 60s. Rita you deserve this award if you can stop puffing on that Winston long enough to claim it.

The Walking Wounded...These tough nosed, hardened nurses can work through bone on bone hip joints, unremitting Crohns Disease, or even while on chemo for aggressive cancers. Tough as nails; the primary objective is to die at the bedside with their Clinic Shoes on. I did manage to scrub on a case one day after having impacted wisdom teeth removed and I was never so grateful that it did not involve oral surgery. The pain sharpened my senses, but I would not never,  ever want anyone to work for this award.

A really good nurse will do whatever it takes to help a patient in need not because it's about award procurement, but because it's the right thing to do. The fact that the obsessive pursuit of awards leaves profound deficits in other areas of direct  nursing care is a definite reality. Emmitt got it right.

Paper Medical Records

A paper medical records trifecta; med cards, kardex

and paper chart. Med cards and anything recorded in

Kardex was tossed after their purpose was served.

The importance of the medical record cannot be overstated. Communication of patient information in a usable format has been a priority for many eons. Where else can you find a blow by blow account of surgical treatment, response to drugs, and basic diagnostic information. Whippersnapperrns complain endlessly about electronic medical records and older practicing nurses often  dream of a return to paper records.
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Paper records had a certain charm and ease of use, but there were problems with divergent formats, inaccurate data, and unauthorized access, which in some ways, mimics problems with electronic records. At least with paper records nurses were not distracted by a wheeled monster of a computer that followed them everywhere. I don't think there is anything more frustrating than communicating with a person distracted by a  computer screen.

 Most private and charity hospitals were writing progress notes and physicians orders on standard 8 1/2 X 11 size paper. Federal agencies such as the VA medical system had a very unique paper size which was 8 X 10 1/2. This was another example of that infamous VA tag line, "The right way, the wrong way, and the VA way." President Reagan established a government Committee for the Simplification of paper sizes in 1980 and the VA switched to the 8 1/2 X 11 standard.

 When a VA patient was admitted to a private hospital the combination paper sizes were difficult to stack (VA patients always had voluminous records) and the end result was a leaning tower of medical records. How acute the lean angle became was dependent on the volume of the record and the sequence of the odd sized paper. Old nurses always characterized the medical record lean orientation as port or starboard. For some obscure reason port side canted records usually foretold a very difficult patient care situation.

Everyone approached patients with leaning  paper medical records with due caution. These were complex, time consuming patients. One nurse summed it up nicely with this little ditty. "Those patients have every case but a suitcase." It was amusing until one of these patient care conundrums actually brought their suitcase with them to the hospital. It could have been much more morbid. When a patient was not expected to recover one family sent along a three piece suit. "Make sure one of the nurses gives that suit to the undertaker when he comes for Gramps," was the instruction.

Today nurses must be concerned with hacks and computer glitches upsetting the delicate order and sequence of recorded medical data. Paper was not immune from unpredictable  disorder. Old time hospitals were never air conditioned except perhaps for the director's office. This meant that nursing stations were equipped with gigantic fans capable of moving as much air as a Piper Navajo on take off roll. That prop wash at the nursing stations was capable of sending any and all stacks of paper flying off into the wild blue yonder.

I vividly recall one sweltering August afternoon  at Downey VA  Hospital when a stack of newly minted physician's orders was placed on the ward secretary's desk for transcription. Unlike patient care areas where the windows had security screens, administrative zones like nursing stations  went screenless. The massive floor fan actually blew the new orders directly out the open  window. I quipped that the records were "gone with the wind." The head nurse, Lois, had the last laugh and ordered me out of the building for order chasing duty.

Another problem presented by paper  pages was how to organize them into a format for ease of perusal by health care workers. There were clipboards and spring loaded metal chart jackets that worked the best. Later ringed  notebooks came into favor, but there were compatability problems with 2 hole or 3 hole. The VA Health system actually  came up with a  novel and unique system of punching 2 holes into the top of the record and affixing it to the chart with a metal hasp.

Data security is a big deal today with HIPPA this and HIPPA that frequently cited. Paper records did not require mixed character passwords to protect. In hospitals there was someone present by the chart rack 24/7 and physician's offices made a ritual of keeping records under lock and key. When a chart was sent with a patient for a procedure or diagnostic test, the chart was encased in a canvas bag with a locking zipper. Data security at it's finest.

Finally. since paper records were always physically close to the patient they communicated a sense of presence. Nothing tells the story of a harried trauma surgery like an anesthesia record splattered with blood or prep solution. The physical appearance tells the story better than the data recorded. Nurses frequently did their charting while taking a break for a Coke and a smoke. It was common to be ceremoniously greeted by a cascade of cigarette ashes when opening the chart to the last nursing note.
Sometimes the "presence" of paper medical records resulted in a messy situation.

Nursing Joins the Money World

There were some sure fire ways to get the boot from a 3 year Diploma school of nursing back in the late 1960's; stealing drugs, falsifying nursing notes, serial uniform code violations, failure to sign in and out of the dorm, having your room light on after 10PM and perhaps the most heinous was having currency in your possession. The student handbook was very explicit on that last infraction.

Students are not allowed to have sums of money in their room our on their person while in the nursing dorm or hospital. It is permissible to have less than $1.50 in change in the student's possession for use in the dorm telephone or for the 25 cent deposit for the use of the sewing machines. Violators will be referred to the School of Nursing Directors office. This violation may result in a determination that  the student is unacceptable for the practice of professional nursing.

The school did provide for virtually all of the student's needs including  books, housing, uniforms, meals, and bed linens. For recreation there were pool tables in the basement, a sundeck on the roof, and a large lounge complete with heavily patrolled conjugal visiting booths with the admonishment that there must be 2 sets of feet on the floor at all times. The nursing school bus made biweekly trips to the Cook County School of Nursing for dips in their beautiful swimming pool.

I think the rationale for the money restriction was to reinforce that you were totally dependent on the school for all your needs. We somewhat derisively referred to the school as "Mother," but it did meet everyone's basic needs for 3 years. All you had to do was follow the rules. We started out with 78 prospective nurses and 24 of us survived to graduation.

Another reason for the no money rule was to reinforce that you were here to "dedicate yourself to the service of mankind." This mantra was repeated very frequently to the extent it felt like being brainwashed. This was a charity hospital and even the doctors were very careful about conspicuous displays of wealth. Dr. Slambow, my surgeon idol, proudly motored to the hospital in his $2,000

Volkswagen Beetle. If he were around today, the first thing he would do is put all the young MDs of today driving BMWs in their rightful place.

Nursing is a calling that has nothing to do with remuneration. Rewards came in the form of caps, bands for caps, and of course that highly coveted pin. According to administrators, angels in white don't need pension plans or decent pay.  If our instructors ever got wind of the notion that we were practicing nursing for the money you were history.

I was watching videos on YouTube of nurses openly discussing salaries for different nursing positions. This would have been professional suicide back in the 1960's and 70's. The first thing we were told about interviewing was to NEVER ask about salary as that would have been the end of the interview.

I think that young whippersnapperns of today have so many financial burdens that we never dreamed about  such as school loans and grossly overpriced textbooks that they have to be concerned with finances. School loans have made education unaffordable. Nevertheless, when I hear a nurse discussing salary or asking for money on a blog for services it sends shivers down my spine. I was harshly conditioned against this line of thinking in my impressionable  adolescent days. I completely understand it, but it creeps my subconscious mind  out because from my experience when nurses talk or ask for money, very bad things happen and you soon find yourself on the outside looking in.

Don't fret, I could never monetize this foolish blog. Who would I "partner" with?  Perhaps hearing aid battery companies or maybe even denture adhesive, I think Polident works best. OOPs I didn't mean to say that. It must be getting past my bed time. I will never sully the "OldfoolRN" media brand (I learned that term from some of you youngsters) with those annoying adds or self serving "partnerships." I learned my lessons about nursing for money at a very young age and those values have stuck like a thick coat of tincture of benzoin.

Nursing provided me with anything that I really needed. Nothing fancy, but the basics were certainly met............Thanks so much for tolerating my foolishness!

The Operative Report

I'm a real sucker for a good read and I'm not talking about the high brow stuff like 19th century British literature; but comic books, Mad magazine, pharmaceutical ad copy, small town newspapers and my all time favorite operative notes which eventually evolved into the operative report.

Today, I suspect these important documents that reveal a blow by blow account of the surgery for the medical record  are done by some type of  electronic computer transcriber that probably deletes the surgeon's editorial or grandiloquent ramblings. Old time operative notes were sometimes handwritten with hand drawn illustrations that rivaled Frank Netter's medical art work. Dr. Slambow always had a red pencil on hand along with blue and black ink pens for his illustrations which proved to me the notion that surgery is  indeed part art and part science.

  Most reports were fairly accurate with technical information such as the type of suture used, sponge counts and anatomical reference.  Some surgeons down played serious problems while others could make a sebaceous cyst excision sound like open heart surgery.

When perusing operative reports that minimized problems, I used to say the surgeon had been struck by hyporeportenosis to amuse my fellow nurses. Once I finished reading a real gem of underreporting that grossly underestimated blood loss and muttered my clever new "hypo" terminology to Nancy, a fellow scrub nurse, and she said, "You better not let Dr. Bruiser hear that." The good doctor appeared on the scene just in time to hear her admonishment to me and about all I could do was act dumb. He began asking about what I didn't want him to hear, so I muttered something about the autoclave cycle taking too long. Whew..another close call. Loose lips really do sink ships or get blabber mouth scrub nurses like me fired.

Blood loss was always a hot button issue for any surgeon and rather than a defined amount  like 100cc, terms like negligible, minimal, or inconsequential were used. Another common explanation for excessive blood loss  was,  "I can't determine the exact blood loss because of all the irrigation we used. That is not blood in those suction containers-it's irrigating fluid, just ask nurse fool."  Anesthesia usually had a pretty good notion of actual blood loss and the surgeons idea of  EBL or estimated blood loss was usually way too low, so the term NBL or negotiated blood loss was the amount recorded in the report after the dust settled from all the anesthetist vs. surgeon arguments. It was about as close to the actual blood loss you could get. Incidentally, a wise scrub nurse always sided with the surgeon in any dispute with those on the other side of the ether screen.


Later in my scrub nurse life, the fun of reading operative reports declined, as dictation became the norm. I really loved those old school operative reports hand written at the scene of the crime in the OR suite immediately following surgery. Some of the old handwritten reports were even "validated" by blood or prep solution splatters because they were always physically present near the actual surgery. Transcribed reports somehow lacked the authenticity or intimacy that those blood spattered reports communicated.

Our surgical  transcriptionists were located in an office just one floor below the OR, and sometimes they would venture up to the OR to clarify a point or try to meet up with the surgeon if they liked the sound of his voice. They would intercept nurses at the double swinging entrance doors to the ORs with their inquiries. Once a harried transcriber approached me with a fist full of reports and asked me if I could help clarify the terminology of the dictator. "You've come to the right place, this OR is a dictatorship and it's loaded with dictators." I replied with a smirk on my face. She did not appreciate my foolish humor, but I used to jokingly ask Dr. Slambow if he was the dictator the transcriptioists were asking about. He tolerated my nonsense well and even grunted a phony laugh because he valued my Mayo stand instrument handling skills.

OR reports always started out boring with pre op and post op diagnosis and a brief patient history. Then they could be very interesting. One surgeon loved the adjective "meticulous." Every time he tied off a bleeder it was "meticulously ligated." When one of his patient's returned to the OR a few hours post op with hemorrhage all the nurses had the same thought. "It looks like one of those meticulously applied ties slipped off or came loose."  As soon as the offending bleeder was located and tied off again, he was back to his old tricks. Sure enough the replaced ligature was meticulously applied just like the original.

Dr. Slambow (uh oh, I almost typed in his real name) liked  to end his operative reports with this statement: "At the conclusion of the case the patient was able to transfer from the table to the gurney under his own power."  I can personally vouch for the veracity of his statement. The process leading up to the patients self-transfer activity necessitated very light anesthesia toward the end of the surgery. This produced some very exciting moments, There are copious (our instructors loved that word) nerve endings  in the skin and the final step of suturing the skin often produced a dangerous situation on that thin OR table. The pain of that suture needle thrusting through highly innervated tissue  induced that flight or fight syndrome and the patient tried to exit stage left, directly into my Mayo stand. Dr. Slambow would say something to the effect. "Fool.. The heck with sterile technique, grab his legs before he kicks someone or flies off the table." All this so the good Dr. could conclude his operative report with his time tested and favorite ending about self transferring.

Surgeons also used operative reports as a mechanism to persuade hospital administrators to purchase the very latest instrument or device they lusted after. There was a left handed surgeon that received reverse ratcheting (left handed) instruments of just about any permutation imaginable. He would describe the odd positons he had to assume with right handed instruments and the next thing we received would be a set of left handed extra long  mixters. Scalpels do not favor handedness and some older nurses used to joke with him about providing him a left handed scalpel. Novices like me knew to avoid joking with these old sourpusses.

These paper reports and their associated carbon paper, staples and occasional validating OR blood or prep stain are gone for good, but they  certainly were good reading back in the day.

Lifesaving Lunacy

Maybe all the healthcare advertising about lifesaving hospitals or nurse "writers" tall tales about nurses saving lives wore me down, but I think the final straw was Mylan Pharmaceuticals marketing their "lifesaving" Epipen. Less than 100 people per year die from anaphylaxis and there is no guarantee an Epipen could have "saved" their life. Even an auto injector syringe required symptom recognition and application of this  grossly overpriced device.

In the meantime, I need a palate cleanser from all this "lifesaving" nonsense. Nancy one of the finest OR nurses I ever worked with frequently answered inquires about her wellness with s snappy response. When someone casually asked her how she was doing, her reply was, "I'm busy saving lives."  One day I asked her, "Do you really believe that?"  She laughed and said "Of course not, but it sounds good." Being facetious is a far less transgression than actually believing you are a saver of lives.

I think some of the  present day lifesavers truly believe their own nonsense and it's time to set them straight. Dr. Slambow, my favorite trauma surgeon, had strong feelings about doctors and nurses as lifesavers. His belief was that we could repair injured anatomy and control bleeding, but the actual recovery is out of our hands. Enabling recovery is a far cry from saving a life. Don't ever let Dr. Slambow  hear a doctor or nurse claim to be a lifesaver. They would be in for a severe tongue lashing.

 Doctors and nurses who  inflate their ego with lifesaving notions put an undue burden on themselves by fostering the delusion of their lifesaving capabilities. It's a tough reputation to live up to. When a patient dies on the table it's not right to think you are a killer and when someone survives it's just as wrong to think you saved a life. It's simply too much of a burden to bear.

I was socialized into a healthcare system that never used braggadocio or swagger to self promote, heck advertising was forbidden and nurses often had a lowly self image. I can't tell you the times I've uttered, "I'm just a nurse." Our self promotion was by our action which often meant crawling out of your warm bed on a cold Chicago winter night for a 3 AM trauma case.

Rather than ego inflating tales of lifesaving nurses, perhaps it's more constructive to take a contemplative moment and realize you did your very best and the patient had a great outcome. Nothing can compare to the experience of seeing a traumatized patient arrive on a litter and walk out of the hospital.

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Coal Shoveling Nurses

As a young foolish nurse, I was admonished by much older peers on many occasions and in retrospect, deserved it. After a lengthy tongue lashing, the senior nurse would often conclude her bitter diatribe  with the qualification, "I was shoveling coal at this hospital before you were even born." Coal shoveling was a badge of honor for these older nurses and they frequently pulled the "shoveling coal card," especially if a smart alecky young upstart nurse suggested or thought a new way of doing things was superior to the old fashioned ways.

Until the advent of scrub suits as  the  uniform attire for student nurses, coal shoveling nurse heritage dictated a proper nursing student's uniform. All the diploma school uniforms were very similar. A blue or grey colored dress covered with a pristine white apron. Of course the white apron was neatly folded and carefully stored while the nurse worked her magic with the coal shovel.

One of the develpments that really rattled older coal shoveling era  nurses to the core was the introduction of disposable equipment in the late 1960's. Glass, stainlees steel,  latex rubber, and heavy muslin cloth were the benchmark in determining the quality of hospital supplies according to these seasoned old nurses. Anything that was  made of plastic or felt lightweight was immediately suspect and deemed inferior.

One of the pioneering disposables was a clear plastic enema  bucket and tubing to replace the standard heavy duty duty steel  cans with latex tubing and hard black rubber nozzles. At least early attempts at disposable enema equipment mimicked the old one by maintaining the bucket. If the switch had been from metal cans to the bags of today, old school nurses would have been totally lost. Older nurses called the disposable enema equipment "toys" and eschewed using such unimpressive, light weight equipment.

Coal shovelers  had many bags of tricks and one of their favorites was hiding old school nursing supplies and equipment that much younger nurses had determined to be obsolete. (Just in case.)  Old nurses always had a contingency plan.

 Our intermittent Gomco suctions were often mounted on a difficult to access cabinet because the big bottle patially blocked the door. These hard to reach cabinets were often packed with old school enema cans, latex tubing, clamps, and nozzles. It made sense  because Gomcos and enemas were both used on GI cases. "I shoveled coal in this hospital so I can use any enema can I please!"  Old time nurses certainly had a sense of entitlement, though it was  well earned.

Older nurses absolutely hated disposable needles and syringes. They had invested labor intensive  resources in learning to properly assemble a glass syringe with matching the correct barrel to the correct syringe. Sharpening needles was an art form and the special needle sharpener tool and it's proper use a source of great pride. If young nurses made pejorative remarks about the foolishness of needle sharpening they were certain to get the coal shoveling lecture delivered in spades by a chorus of oldster nurses. Until the mid 1970's there was often a rotary needle sharpening tool hidden away in a special unused cabinet or ward locker. I have even witnesses old time nurses sharpening disposable needles just to keep in practice. Old habits die hard.

Old nurses were also on constant lookout for ways to reuse disposable equipment. I vividly recall one elderly nursing supervisor suggesting that used "disposable" endotracheal tubes could be repurposed for retention enemas or barium enemas. " The cuff was the perfect lumen to suitably block exit from the colon. "I bet these endo tubes are radio-opaque so the radiologist could verify proper position in the sigmoid colon. I'm bringing this up at our next procedure committee meeting, "  said one old heavily wrinkled supervisor.  Whenever one of these elderly repurposers came across the ONE TIME USE  warning on disposables it just added fuel to the fire and the conclusion was that one time use as an endotracheal tube and one time use as an enema tube was perfectly acceptable. Twice the bang for the buck.

The next occasion one of you whippersnapperns don a complete surgical glove to insert a Foley, take a moment to remember  that you are standing on the shoulders of oldfoolrns like me  that could slide that Foley in place using only 2 (two) sterile fingercots. I never shoveled coal, but I do have a lengthy repertoire of  ancient nursing skill sets.

Tuck those uncovered fingers into a fist and

now grab that Foley between your index finger

and thumb. The hard part was "rolling" into that

first finger cot without touching it.

A Picture Story

Pictures really are worth a thousand words. This story is circa 1967 and from the golden days of big open surgeries to remove a tiny piece of pathology.  Just about every case on the schedule was for an -ectomy or removal of something. We used to carefully time the incision to  specimen in the bucket interval and the surgeons used to treasure the bragging rights of being the quickest.  It was very crude compared to the repair and replace laproscopic culture of today.

My favorite photo is #6 with that gamine looking  circulating nurse eyeballing the scrub nurse. I used to get that look from my favorite supervisor, Alice, all the time. I was always tempted to "accidently" toss a loaded, used, sponge ring forceps in her direction. "OOPS.. so sorry about that Alice.

The cloth gowns and drapes, compete lack of eye protection, glass IV bottles, and huge soda lime canister on the anesthesia machine all look very familiar to an OldfoolRN.