Alice Was the Grand Poobah of the Operating Room

God bless dear old Alice until she eats you alive

I've posted many times about my all time favorite OR supervisor, Alice.  During these sometimes discordant  COVID times I miss her strong willed imposition of order and discipline. Alice was like a gas heeding the laws of physics.  She could fill the entire room with her  presence  by virtually wearing authority the way a meticulously attired nurse wore her blindingly white uniform. At the ripe old age of fifty something, command was hers because it was earned by spending decades in the boiling cauldrons of  operating rooms and their combative surgeons. She had dodged more flying instruments and administered more scores of painful knuckle bashings with a sponge stick than I care to remember.

Her repertoire of corrective interventions consisted of humiliation, infliction of pain and  shows of physical strength (Alice had the upper body strength of a linebacker on steroids.) Pain was usually delivered by a snapping blow to the wrist and/or fingers by the business end of a long sponge stick. The length of this instrument could deliver a blow of variable power based on where the fingers grabbed it to form a fulcrum. I usually sustained  the full meal deal for my transgressions with Alice grasping the instrument at the hinge and really winding up. Passing an instrument to a resident before serving an attending or counting sponges too fast or slow were typical transgression. Any break in aseptic technique was also harshly corrected.

While scrubbed on a long, grueling oncology case I began subconsciously doing hamstring stretches at my Mayo stand and lo and behold Alice strolled in. I knew I was in for one of Alice's lectures about how scrub nurses were supposed  to be uncomfortable and any unnecessary movement was a vector for the spread of that dreaded entity known as perineal fallout. Personal comfort and well being of her charges was as much  a priority to Alice as mindfulness was to Moe Howard of The Three Stooges. Luckily, Dr. Slambow saved my hide. As he was meticulously fileting a duct he said, "Alice can't you leave him alone. I can't do this without him." It really paid off making
your services indispensable to surgeons. I always thought of it as the best job security move a scrub nurse could make.

Alice's show of physical strength was also quite impressive. I've seen her single handedly transfer patients of her weight with the ease of an Olympic weigh lifter. She claimed that manually cranked beds were one of the best forms of upper body exercise and who would argue that point with a hulking Alice?

Alice made it a special point to mentor medical students in her own unique fashion. I knew what was coming next when one especially whiney student complained she could not see the operative field. Alice stealthily approached the novice from behind and ram rodded her lunch hook-like hands under the miscreant's arm pits and lifted her a couple of feet off the floor. She always followed maneuvers like this with a suggestion to utilize platforms instead of bitterly complaining.

Old nurses like Alice lived for nursing which was the alpha and omega to their life. Her idea of self care was a quick break for a Coke and a smoke. I never questioned Alice's dedication to her patients because it was her whole life.

Don't Crash That Gurney

It's all fun and games when pushing an old Gurney in a straight line.

Objects moving through space at high speed with a sense of urgency are prone to mishaps. No, I'm not talking about the space shuttle Challenger. I'm thinking of  old school hospital Gurneys which were also known as prams, trolleys, or carts. These unwieldy conveyances had tiny wheels which were really more like casters. Each wheel had an independent locking mechanism that was activated by stomping on a tiny lever.

Adding the weight of a patient to the cart  resulted in a very high center of gravity that conferred an inherent lack of stability. Vintage Gurneys had no counterweights in their base like the meticulously engineered transport devices present in today's hospital. Tiny wheels, poor brakes and a high center of gravity were the recipe for disaster.

Pushing an old fashioned Gurney in a straight line at low speed was a walk in the park. Speed, uneven terrain, sharp corners or heavy loads were complicating issues and relevant factors in Gurney crashes

Crack ups while rounding corners with a loaded hospital trolley had some of the same elements as motorcycle wrecks. I've had personal experience with both types of mishaps. High side motorcycle and Gurney crashes are among the most catastrophic because the patient I mean, rider is thrown off the vehicle ahead of the line of travel of the vehicle and risks not only the fall but the cart or bike then plowing into him. The cause of these crashes is suddenly regaining traction after sliding or skidding around a corner. In the hospital any type of liquid spilled on heavily waxed terrazzo floors is the most common hazard responsible for high side Gurney mishaps.

More benign crashes are of the low side variety where the bike or   Gurney simply skids around a corner and the conveyance  slides sideways gently spilling the patient. Thankfully, this is probably the most common type of Gurney crash and results in minimal injury because the driver is often able to contain the patient before he impacts the floor. Collateral damage from broken glass IV bottles is a common complication of low side wrecks. The Gurney driver is usually in an emotional hyper response  state with marked frontal lobe detachment  after one of these mishaps and hastily picking up glass shards can result in colorful displays. Please, don't ask me how I know about this one but the scars on my fingers are probably a dead give away.

Another factor in gurney wrecks is overloading or raising the center of gravity by personnel standing on the cart for procedures like joint reductions.https://regionstraumapro.com/page/3.  This graphic illustration of an intrepid emergency medicine physician is a good example of a high flying reduction. Hopefully the good doctor  returned safely to terra firma when the procedure was completed.

CPR perfomed on a rapidly moving Gurney always reminded me of a rodeo where a sudden fall is awaiting  the rider.  The nurse performing compressions (somehow it was always a nurse in the saddle) straddled the patient while maintaining the exquisite balance of a Brahama  bull rider as the Gurney surged forward toward more definitive care. Once again the center of mass is raised and the urgency of the situation always manages to exacerbate the propensity for a mishap. The nurse furiously doing chest compressions above the patient was the canary in the coal mine since she was likely to take a tumble before the patient fell. Caution usually prevailed when the Gurney driver sensed the CPR provider was about to take a tumble and slowed everything down befor a crash ensued.

Just like Gundam mech robots patrolling an infinite universe,Gurneys were just about everywhere in the hospital orbit. Gurneys always held a warm spot in my heart because I saw them as a symbol of unification and, oh boy,  we could sure  use some of that in these difficult times.. We are all going to take that last Gurney ride someday no matter what event terminates our earthly existence. Pay close attention to the next soul you see on a Gurney because they can show us all how to take that final ride with a dignified sense of peace. All bets are off if an OFRN like me crashes the cart.

Writng on Bed Sheets

Spotless white sheets were perfect for bedside note taking

I'm a diehard aficionado of the esoteric little nuances present in hospital culture. Before  I begin writing (if you could call it that,) a Google search is usually in order. If the topic I had in mind fails to show, I have a winner. I googled nurses writing on sheets and up popped, report sheets, hand off sheets, ICU cheat sheets, and brain sheets. Ahh...perfect, nothing what so ever about nurses and doctors physically writing on hospital linen. 

Seasoned, well past their prime doctors and nurses scribbled on hospital sheets all the time in vintage hospitals. The usual weapon of choice was a ball point pen, but a fine tipped felt marker would do in a pinch. Pencils simply did not cut it for sheet writing and were usually in short supply. Some physicians are inventive and I have witnessed sheet scribbling done with a broken applicator soaked with  Zepharin  solution which added an artsy fartsy touch to their scribbling  due to it's bright reddish/pink color.

Anesthetists in the OR loved to keep track of things like units  of blood or dosages by scribbling hatch marks on the sheet near the patient's head. Procedures calling for an intraoperative position change would frequently throw a monkey wrench into linen record keeping systems. The vital hatch marks could all to easily relocate to an inaccessible position. Another SNAFU was keeping simultaneous tallies such as one for units of blood and the other for ventilator settings and then confusing one recording for the other. This could lead to strained conversations such as, "Those markings are for the units of packed cells and this one over here is for tidal volume...or is it the other way around??"

Orthopedic surgeons were frequent sheet scribblers and left notes for the proper positioning of traction equipment. Before Campbell's Operative Orthopaedics became the dominant textbook, closed reductions with traction ruled the roost. All those weights, slings, and pulleys just called out for sheet side illustration.

Pioneering total hip replacements were affectionately referred to as low friction arthroplasties and required complex post-op nursing care. Hemovac drains required constant attention to maintain patency and Pehr splints to prevent abduction generated lots of twiddling. Putting an octopus to bed would have been small potatoes compared to caring for total hips.

Arthroplasty patients were to stay flat on their backs for 7 days and could not be turned side to side to make a typical occupied bed. The arduous procedure entailed suspending the hapless patient over the bed while making the bed from top to bottom. Many students sought to avoid the linen change ordeal by carefully maintaining the condition of the bottom sheet. Miss Bruiser, my favorite instructor, was always one step ahead of her intrepid students. She would make a tiny mark on the sheet in an unobtrusive spot and then check back to see if the sheet was changed by observing for the absence of her mark. If the mark was observed after the student finished morning  care a tongue lashing and demerits were liberally issued.

An  unusual sheet writing adventure occurred in the OR just prior to an induction. One of the staples stocked in our break room was canned sardines which were opened by inserting a special key into a slot and unrolling the top of the tin. The discussion among the surgical residents was how to open a can of sardines without the key. A diagram of a sardine can was scribbled on the top sheet covering the patient and the explanation ensued. "The first step is to center a knife over the crease (in the can) and make a fist around the knife. Next strike the top of your fist until it pops open." The patient thought the good doctors were discussing operative technique and let out a shriek of horror. It took several minutes of explanation to restore order and calm the patient. You can never be too careful when patients are awake in the OR!

Corona Pandemic Hits the Nursing Culture Reset Button

A few days ago, I passed by a nearly empty hospital parking lot. The  ER entrance was backed up into the street with all sorts of emergency vehicles  so there was  no shortage of patients. Sirens screamed in the background and the place was hopping.

 The lonely vehicles present in the parking  lot were of the Ford Focus or Toyota Corolla permutation. It wasn't too hard to deduce where the BMWs and Infinitis  with  their nursing themed vanity license plates had gone. The self proclaimed  elite members of the nursing academic/administrative office sitter complex were holed up in their fancy abodes while a dedicated contingent of bedside nurses were slogging it out  in a challenging environment with a crude hodge-podge assemblage of personal protective equipment.

The righteousness of the busy body administrators at the top of the nursing administration pyramid looks especially iffy when lowly bedside nurses lack even the most basic equipment for safe patient care. Bedside nursing is a tough, often thankless undertaking and a lack of support from above for necessary equipment exacerbates the misery. Bedside nurses have a long history of facing insurmountable difficulties. Florence Nightengale lasted only 3 years at the bedside.

In years past, charity hospitals with no concern for personal financial gain were the  institutions that sanctioned and preserved nursing culture.  No patient was ever asked for an insurance card or copay. Everyone was welcome and eligible for care rendered out of kindness without a preoccupation with remuneration or the bottom line on a spread sheet. There was a strong feeling that we were all in it together for a greater good.

Money is the sand in the gearbox of healthcare today and the end result is a public health meltdown. Reimbursement for heroic, expensive  procedures without improvement in  patient outcomes grease the skids in hospitals of today. This one for all and all for one approach does not meet the needs of a population that  is threatened by a pandemic.

It's no wonder countries with readily available healthcare not dependent on an individual's wealth or yoked to employment  are doing so much better. You cannot buy your way out of a pandemic with profit centered care. In the land of the free and the home of the brave we do have the very best healthcare money can buy and it's proving to be lacking. Folks here are lucky if they can even get tested for corona virus.

Nursing is about to change and nobody is sure of the "how," but people in crisis help each other. Caring  for those near us begins widening the care net for others. Maybe the nurse office sitters will emerge from behind their computers and help others because it's the right thing to do. Experienced nurse "rockstars" will rejoin the band and help young nurses at the bedside instead of soaking   funds from a vulnerable group of nurslings for overpriced video courses. Nursing is not about being an Instagram influencer or money changing hands. It's about helping others without concern for self.

Just maybe the pandemic will  transform nurse entrepreneurialism  with it's  inner impulses geared for money grubbing and influencer prestige to more charitable  values delineating our nursing lives - duty and responsibility to our patients. Preoccupation with over indulgent, extravagant, nurse "self care" be damned. We were meant to suffer along with our patients. Oh..and  don't let me forget, sometimes at the hands of our patients.https://oldfoolrn.blogspot.com/2015/08/knock-out-punch.html

Were You Ever Afraid of Contracting Somthing From a Patient?

  I was almost infected with greed fever

Someone on Quora asked me if I was ever afraid of  contracting something from a patient and a plague of answers began swirling around  in what's left of my ancient cognitive vault. Hmm...was it Hepatitis C, influenza, or step throat? Well, no, something else suddenly came to mind and it did not involve a bacterium or virus. It was pure unadulterated greed. Something all too ubiquitous in today's healthcare world and as contagious as the most virulent virus.

As a novice nurse one of my patients was confined to a self imposed isolation in a private room on one of the nicer hospital units. He had a high forehead with bushy eyebrows and  a prominent jaw line that did not betray a hint of weakness or doubt. He had a definite presence about himself.  His name was Ray Kroc and the McDonalds restaurant empire was his brainchild. Billions and billions of burgers meant big bucks and a lifestyle ordinary folks could only dream about.

 The reason for his hospitalization was weight loss. One too many BigMacs had taken a toll on his waistline and rather than purchase a bigger belt he checked into the hospital for a carefully supervised dietary regimen. Rich people do strange things and a  huge monetary donation reserved his hospital bed. Money can buy anything.

He was very friendly and interested in the workings of a big city hospital. After hearing a few of my tales about hospital experiences he came up with a grand  proposition for me. His business sense told him there was a pent up demand for male nurses and not all that many nurses carried XY chromosomes. According to him, a nursing agency for male nurses could be quite lucrative with careful marketing.

I looked down at my lowly Timex watch and compared it to the gleaming Rolex on his fat wrist. Hmm, I thought, maybe I could swap my Raleigh Super Course bicycle for a motor vehicle. I was just about to contract a very bad case of greed as dollar signs danced in my head.

Then I came to my senses. Greed suppression was an integral component of nursing education. Nurses weren't supposed to have much of anything. The ANA code of ethics even prohibited RNs from endorsing any commercial products. All the nurse influencers of today would be in big trouble as money making was definitely not in the cards for a nurse. Nurses were supposed to be selfless caregivers often at their own expense.

I began to think of all the experiences I would miss if I were worried about my balance sheet instead of the names on a Kardex. Being well off financially disconnects you from the day to day activities  that define the experience of everyday folks. I would have missed out on the warmth and caring shown to me by a homeless person in the ER  when he taught me how to keep warm in a Chicago winter by wrapping layers of newspaper around my extremities. I hoped I would never need the skill, but the kindly way it was explained to me stayed with me. I can still see his warm smile.

When nurses leave a  patient's room after a failed code they seldom look back. Somehow I managed to corral my greed impulse and never looked back. An agency for male nurses sounded like a dubious proposition and, besides,  I always thought of myself just as a plain old nurse. No gender qualification needed.

Bed Scale Blues

It's easier to push a stalled '57 Chevy than a bed scale!

I made the mistake of reading some of my old posts and some of them resemble a distant ping from a satellite knocked out of orbit. Tales from a far away planet where bedside care was the only currency that mattered and what little money there was flowed away from nurse's pockets. It sounds paradoxical, but the more interface I have with "modern" healthcare, the more I miss the old days.

Oh well, Nero's circus must go on so here's my take on vintage behemoths that were part Hoyer lift, part ironing board, and finally part piano mover's dolly with enough free weights to open a gym. Bed scales were the hospital version of battleships, difficult to change direction when in motion, fraught with danger and best left alone.

The illustration above shows an intrepid  young nurse in transit for her mission; to weigh a bedridden patient. The ironing board part of the scale is hinged so it's vertical when in storage or moving  struggling down the hall. It's visible on the right side of the scale just inside the counterweights. After an arduous journey to the bedside, the ironing board like platform was tilted to a horizontal position. The patient is pulled, pushed, or glided onto the awaiting platform. You know, that old count to three and grunt routine.

The platform is elevated like a not so magic carpet by way of a hydraulic Hoyer lift like pump. Now for the fun part -  where the rubber meets the road. The patient is suspended inches above the bed while the nurse turns her attention to balancing the counterweights. A potential  hazard included becoming distracted by the precarious position of the patient and dropping a 20# weight on your foot. Clinic nursing  shoes did not have a safety toe so that's really going to leave a dandy bruise, if you are lucky. The not so fortunate will see the ortho clinic with compound fractures of the metatarsal bones.

One of the great nursing debates involved the question of including peripherals (How about that? I managed to hijack a term from the computer industry.) like Foley bags or surgical drains in the bedside  weight. The free spirit nurse simply tossed the Foley bag or drain apparatus into the mix and included it in the final weight. Dangling Foleys and drains were always at risk for unintended extrication during the transfer or elevation process so I usually left them be and subtracted a pound for the tare at the conclusion of the procedure.

One of my most colorful nursing instructors, Miss Bruiser had a favorite saying, "Work smarter; not harder." Every nurse hated bed scales with a passion and looked for a smarter procedure when it came to patient's weights. In nursing research there are methods for assuring interrater reliability so that results are consistent. Nurses weighing bedridden patients took a lesson from carnival weight guessing hucksters and followed suit. Before the bed scale weight was determined, the nurse took a guess at the patient's weight. When her guestimate came within 5 lbs. or so she became a certified patient weight confabulator. Leave that massive bedside scale in the clean utility room and bring in the certified nurse weigh approximator. These nurse's were also trained experts at clairvoyant counting patient's  respirations.

What happened to Mop Swinging Nurses?

"That spot you missed will cost you 10 demerits"

Nurses from my generation knew their way around a janitor's closet as well as whippersnapperns know how to monkey with a Pixis. Mopping floors was an integral part of any diploma school nursing education curriculum. Just when you thought nothing could top scrubbing mucous/emesis stalactites from bed frames, mopping madness was introduced.

The swabbing the deck curriculum began with an orientation to perhaps the most important and critical cog in the hospital hygiene world which was the lowly slop sink. These marvels of plumbing technology consisted of a square, slightly elevated receptacle just inches off the floor. They were marble back in the day, but toward the end of my nursing days they were (gasp) fiberglass which definitely  lacked presence and looked cheap. Slop sinks close to the floor were a real boon to a nurse's back because the massive 30 liter buckets could be filled and emptied with minimal lifting. Filling buckets was lots more fun than emptying the bacterial/blood/stew medley that frequently accumulated after a mopping session.

Home base for the RN mop crew was a trolley consisting  of two 30 liter buckets on a mobile platform.  Bucket # 1 was filled with 19 liters of hot water and a foul smelling witches brew of ammonia compounds and an overpowering  detergent that really meant business. The ratio of solution was 10:1 and this factoid was always a question on just about any test. Bucket #2 was equipped with a wringer and Miss Bruiser, my favorite instructor, claimed that aggressive mop wringing was good for the bust line. I don't know about that, but my signature move was twirling the high modulous cotton/rayon mop head as it settled into the wringer which really got the juices flowing (the mop's, not mine) when the wringer mechanism was actuated.

Alice, my favorite operating room supervisor was equally  adept at mop swinging as sponge stick loading. My mopping abilities were honed to perfection by lessons from Alice. She  said to always pull the mop toward you while moving backwards. I modified her technique to a sideways  stance after backing into a kick basin and nearly breaking my neck in a free fall to the floor. After that episode I often referred to them a trip basins.

I actually enjoyed mopping operating room floors. The rhythmic swinging of the mop had a meditative component to it and I loved seeing the immediate results of my labors. After dealing with verbally assaultive surgeons and aching fingers from loading needle drivers, mopping was  a refreshing oasis complete with the soothing sloshing of water. A gift.

In the sunset years of my work in the OR, young nurses were surprised at my love of mopping and suggested there might be a better use for my skills. I was far too compliant to question mopping duties and too foolish  to refuse, after all, I was doing it for the patients. Old nurses would do just about anything for their patients.

Today on my frequent visits to hospitals as a patient, it's as though I'm entering the Twilight Zone. I don't know which is worse, carpeted floors or the total absence of moppers of any permutation. Modern hospital have descended to a hellscape of ubiquitous beeping and bleeping electronic doo-dads with nurses caring for computers on wheels. I would much rather be wheeling around something of substance like a fully loaded mop trolley.

Clandestine Patient Restraint Techniques

Nurses providing ambulation assistance 

for an afternoon nap.

Restraining patients is probably one of the most unsavory elements of nursing practice and old school practitioners were masters of obfuscation when it came to forcible restriction of movement. Even office sitting nurses of the academic/administrative complex eschewed patient restraints. Everyone did their very best to find ways around outright restraint of those under their care.

Memos from on high regarding patient restraints were filled with officialese and gobbledygook in an attempt to camouflage what was really  going on. I found a VA restraint and seclusion Professional Services  Memorandum that illustrates this point: VA Form 10-2683, Report of restraint and seclusion.  "The doctor's orders (SF508) will be initialed by the GS9-11 ward nurse. The nurse will copy the prescription (form 10-2913) on the nursing notes (SF510) indicating the type of restraint and 24 hour report of patient's condition (VA form 2915). The nurse in charge of the ward during each tour of duty will maintain a record of each application of restraint on VA form 10-2683. After the last day of the month, the nurse will sign this form and forward it to the Registrar Division - 114A."  Some head nurses referred to the monthly reports as the "Funny Papers" because restraints were not always used according to Hoyle with the frequency of use almost always understated.

Downey VA Hospital, the long term psychiatric hospital I worked at in the early 1970s made extensive use of full restraints that consisted of heavy leather cuffs secured by robust belts. My ways of caring for these patients were unique and foolish, but averted some  of the unpleasantness associated with 4 point restraints. I began a patient enlightenment program that involved patients recognizing when they were beginning to escalate and request restraints before anyone was injured. A veteran of the Viet Nam war summed things up quite  nicely, "Restraints are just like an Asian civil war-much easier to get in than get out." I couldn't have said it better myself.

This illustration clearly shows the time tested maneuver aptly called "let me hold your hand...DOWN. Whether inserting nasogastric tubes or assisting with  excruciating procedures like the removal of Jackson-Pratt surgical drains, every old nurse had experience with this one. Initially, good intentions entailed holding the patient's hand for support, but soon evolved  into a vice grip not unlike the panic induced squeeze on the overhead bar of the Ravenswood EL train as it rounded an acute bend. Hold that patient's hand like a trapeze  artist grips the bar while the good doctor gives that J-P drain one final yank.




Distraction is another useful tool in the nurse's position inhibition  armamentarium   (please note, I did not use that dreaded "R" word.) This trick procedure does not work well with painful ministrations about the head and neck, but is very effective for procedures below waist  level like bedside urethral dilitations or removal of orthopedic external fixation devices. The nurse elevates the bed so that the patients eyes are close to the height of the nurse's ocular orbs. The patient's  head is immobilized between the hands as the nurse locks eyes with the hapless patient. Extreme eye contact seems to slow things down  and put a damper on some of the unpleasantness.

Children are especially vulnerable and the isolated snippets  in my mind of pediatric restraint have long sense departed. Whew! Am I ever happy for that. There is a harrowing  pediatric restraint device known as the  Pigg-O-Stat. Google it if you dare. This thing looks like a blender with the lid off and the youngster is dropped into it for X-ray procedures. It's no wonder so many people have claustrophobia later in life. They were probably popped into a Pigg-O-stat as a mere youngster.

 One of the more humane child restraint devices is a take-off on the old Trojan Horse idea. The restraint device is a toy rocking horse that lures it's young patients by whimsical looks, not brute force. While the child plays horsey, an X-ray plate is slid into position and the exposure made before anyone is the wiser. An elegant restraint solution! I wish they all could be so easy.

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.

Looking Good - Feeling Bad

Back in the late 1960s  cures for serious illness were few and far between. Undaunted by bodies mutilated by serious illness, old school nurses were true artisans when it came to making sick, debilitated  patients look good. That old adage, You can't make a silk purse out of a sow's stomach, did not apply to these embellishment minded nurses. Cachexia never looked so gorgeous.

Every bedside nurse was a master when it came to the quick shave. A wash cloth heated in the blanket warmer served to mollify the most robust beard. A few deft strokes with a prep razor produced a dapper looking patient despite the paroxysms of sustained DTs of an alcoholic in the process of sobering up.

Shaving had one well known complication. Intubated patients always had  that pesky pilot balloon dangling in the razor's path and slicing into that tiny little bubble resulted in lots of excitement. A massive leak around the deflated cuff of the endotracheal  called for a STAT reintubation, but, at least, the patient looked nice if you could overlook the terrified expression elicited by a crash intubation..

Another trick in the looking good procedure manual was fooling  around with the lighting. Jaundiced patients always looked much worse under incandescent illumination, so open the drapes and turn off the overheads in the room. Avoiding yellow bedspreads helps too. Patients with an elevated bilirubin of 4 mg/dl  never looked so good.

Out of sight, out of mind was the philosophy of wound management and the bigger the surgery, the bigger the dressing. Abdominal surgeries incorporated another layer of obfuscation, the scultetus binder. A patient might feel as though their belly lost a battle with a chain saw, but hey, they can't see a thing until that dreaded dressing change.

The importance of accessory items such as eyeglasses and wrist watches in the looking good gambit  is illustrated by the sad tale of a 47 year old man suffering from terminal heart disease. Haskell Karp of Skokie Illinois was the first recipient of an artificial heart. Famed Texas heart surgeon, Dr. Denton Cooley made quick work of the situation and in a 47 minute surgery the artificial heart was in place. The device functioned for 3 days when a transplant became available, but death came 2 days later from operative complications.

It was especially important that a patient  fortunate to receive  doomed by the first totally mechanical heart to look attractive. This was international news and lots of folks were watching. Nurses went all out  to convert what was a terminal event to a flattering photo op. The illustration below shows Haskell fresh off the operating table awaiting the return of consciousness and the delivery of The New York Times. Reading glasses in position for a cursory perusal of the business section. Looking good!

Haskell Karp   Circa 1969

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.

The Smoking Finger

No, I don't have one of those fancy new fangled phones

that take photos, so I put what's left of my index finger in the scanner.

Surgeons and nurses toiling in an operating room become habituated to a very controlled environment where everything from lighting to air quality is subject to rigid regimentation. Unpredictable events throw a monkey wrench in the midst of this enforced order, often times, leading to a cascade of adverse events  which can result in personal  injury to staff.

Voice modulation morphs into a surgeons unduly harsh verbal  admonishment of the offending party. Harried nurses, desperate for a resolution to the problem throw caution to the wind and find themselves in a precarious situation while attempting to solve the problem. Desperation seldom leads to reasoned thinking. The ensuing pandemonium is enough to flummox a pope.

Operating rooms can be dangerous places. Surgeons waiting for someone to fall asleep before cutting them might, at face value, seem unsavory, but the notion of live by the sword; die by the sword holds true in the OR.  Those sharpened chunks of stainless steel do not discriminate when inflicting their trauma and Bovies don't care what  tissue they roast.

 As a circulating nurse I was known for constructing elaborate platforms for height challenged scrub nurses. My colleague, Janess, loved my elevation tactics and was so enamored with one of my creations she failed to notice an unusually low hanging overhead light. As she emergently  ascended my stairway to operating room heaven for an urgent trauma case,  the crown of her head struck the low hanging illuminary with a sickening THUD..CRASH. After finishing the case, a close inspection of her cranial vertex revealed a hematoma the size of the distal end of a Babcock. After a quick neuro check and 15 minutes with an ice pack she was back on duty. I've witnessed several intraoperative injuries to staff and not a single nurse or surgeon broke scrub, no matter the extent of the injury.

Karma can be a cruel mistress and I soon received my payback for contributing to Janess's unfortunate mishap. I was finishing up a case with Dr. Oddo that entailed resecting a menengioma. These tumors are outside the brain and with removal have an excellent prognosis. I was in a great mood thinking about how we were actually being  of some service to the poor soul suffering from this nasty,  neoplastic malady. One thing I've learned over the years is to be wary of those euphoric Kumbaya moments when everything seems to fall in place because a true shitstorm is often in the works.

Dr. Oddo had been using a foot pedal actuated Mallis bipolar cautery during the case. This nifty little device looks like a pair of tweezers with an electric cord attached to a high voltage generator. When Dr. Oddo tramped on his foot pedal electricity flowed between the tips of the tweezer like device cauterizing anything in between. It was a great little gadget for controlling bleeding in small vessels.

Dr. Oddo loved to instruct the anesthetist to lighten the anesthesia near the end of a case. One  of his favorite phrases in the post-op report was, "The patient was able to transfer from the OR table to the awaiting carriage independently." This sometimes made for exciting moments near the end of surgeries when the patient took ambulatory surgery to a new level and decided to bail out before the final skin sutures were in place.

Sure enough, just as Dr. Oddo started closing the skin flap the patient began to emerge from general anesthesia. As he came to, his right leg spasmed into a mighty lateral kicking motion impacting Dr. Oddo's leg poised with his foot just above the Bovie actuating pedal. I was tidying up by clearing off the operative field and was preparing to wipe down the distal, business end of the Bovie forceps. The patients kick to the good doctor's leg turned the Bovie forceps ON and as the juice flowed a sickening burnt flesh/charred rubber glove malodorous scent filled the air.

The Bovie had cooked my right index finger on the distal phalange. As the smoke cleared I requested a new glove and plunged  what was left of  my smoking finger into a fresh sterile barrier. There must be some truth to the notion the body releases pain killers when traumatized because initially I was pain free. Upon finishing the case and pealing off the second glove the extent of the injury became apparent. The end of my finger had extensive "remodeling" with the distal aspect about 1/3 AWOL.

Dr. Oddo helped me remove the melted latex glove from the wound and suggested wrapping the finger with iodoform gauze. Dr. Slambow was consulted and said "welcome to the club" while showing off a massive scar on his right palm. After about 4 weeks, it was time for the unveiling. Dr. Oddo involved himself in a spirited debate with Dr. Slambow questioning whether  the nasty blackish tissue around the wound was eschar or scar tissue.

After the unveiling and the scar/eschar mess was pealed off I had a functional but rather disfigured index finger with a square tip and missing 1/2 the nail. I never missed a day of work and today I regard what's left of the end of that finger as a badge of honor. It's better than thinking of it as a living monument to my foolishness.

What Was the Official Cigarette of Your Diploma Nursing School?

There were so many diploma schools of nursing in the 1960s that each class adopted their own unique motto, school colors, and slogans. There was no formal mention of the fact that each class had their own preferred brand of cigarette. Brand loyalty was the byword and everyone wanted to feel part of the same "club," so there was minimal deviation from the standard brand of smokes.

I dug out my old nursing yearbook from my basement  junkpile archives and refreshed my memory. Our class colors were light blue and navy blue, class flower was a white rose, class moto was A journey of a thousand miles begins with a single step, and the class philosophy was "I have no yesterdays ,tomorrow may not be--but I have today." Last, but not least the class cigarette was KENT. Student nurses tended to mark their territory and Kent cigarette butts were virtually everywhere. Favorite ashtrays included the orthopedic beds with big gaping holes for attaching traction bars and even unused suction bottles on the Gomcos used for demonstration.

Cook County School of Nursing students lived up to their hardcore image by smoking disgusting unfiltered Phillip Morris Commanders. You could always identify a Cook County Nurse by her nicotine stained brown fingers.

Ravenswood hospital was bicultural when it came to cigarette usage. Both Kools and Winstons were in vogue here. I guess the nurses could not come up with a consensus which was a frequent problem in nursing when critical decision making was required.

When I relocated to Pittsburgh the official cigatrette custom was in full force. At Montefiore Hospital all the nurses smoked Salem Light 100s. I think the 100mm length was a thoughtful choice because it served as a break extender.

I betcha Nurse Bonnies classmates were Red

Apple Smokers. An apple a day keeps the Dr. Away??

Skin to Skin Post Mortem Care

Skin to skin contact meant something entirely different to me than the currently popular post partum mother / infant tactile bonding technique. When I first heard the term, I asked myself  How in the world did someone discover one of my personal secrets?  I  felt compelled to lift the patient from the death bed or OR table with my bare arms contacting their skin. It was part of my way of saying goodbye.  There was a trick to this that involved spreading the morgue shroud open on a nearby Gurney with the distance dependent on the patient's weight. A 50 kg. patient could have the waiting litter across the room while a 100 kg "heavy hitter"  better be close to the bed. I tunneled my right arm under the patient's shoulders for a mid axillary target and my left arm went under the knees. A helper carefully supported the head while I carried the patient to the cart. There was something special about being there in actual contact with the patient skin to skin as they say. I always said a silent prayer for a peaceful journey to a peaceful place as I gently lowered them to the awaiting shroud.

Every old nurse had something unique and special to impart during post mortem care. Jane who was a dental hygienist before becoming a nurse always offered meticulous mouth care to the departed patient. When she was done the waste container was always filled with lemon glycerine swabs and an empty peroxide bottle. Bonnie hated to leave any tell tale sign of invasive medical procedures. The first thing she went for from the supply closet was adhesive tape remover and cartons of 4X4s. Every little bit of residual adhesive tape was lovingly removed. We did not have those fancy task specific devices to stabilize endotracheal tubes and all that tape about the lips and around the neck made an unsightly mess that Bonnie always made disappear. Lois hated those flimsy shoelace-like ankle and wrist ties and always substituted soft strips of wide Kerlix. After her gentle ties were in place she often kissed the patients hand. I hope I have a nurse like Lois when it's time for me to enter that shroud. I'm certain the journey to the other side will be pleasant with a send off like that.

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.

When and Why Glass IV Bottles Disappeared

Glass IV bottles were all fun and games until you dropped one.

Up until the early 1970s you could receive your IV dispensed from any container as long as it was a gleaming glass bottle. These time tested and trusted  vessels had been the workhorse of infusion therapy for decades and possessed a sense of inertia that suggested  they would be around almost forever.

Having been raised  with glass IV bottles, older  nurses had a special reverence  for them. It was easy to view the level of remaining fluid and  glass was inert to allay any worries of interactions with the fluid contents. A strip of ordinary adhesive  tape could be easily applied to the side of the bottle with the time marked for the fluid levels. Pumps and controllers were nonexistent so we counted gtts/minute (gtts is a Latin abreviation for "gutta" meaning drops.) It  always amused me how health care folks  used  Latin to obfuscate the issue, but alas, that's a post  for another day.

KCl  and B&C vitamin supplements could be added to bottles without even using a needle, just plug that naked syringe into the air vent and inject away. I used to relish the visual treat of the deep yellow vitamin solution as it merged and mixed with the clear IV fluid in the bottle. Inject the colorful solution rapidly and a model of a spinning water spout could be replicated. I've heard the term "lightening in a bottle," but a miniature water spout was even more impressive.

 Nurses mixed all  IV fluids  on the patient care  floors, no need to involve the pharmacy with all those superfluous phone calls or redundant paper work. The air vent had another feature nurse's came to know and love. As the air bubble gurgled it's way through the fluid in the resonant glass botle to equalize  pressure, the soothing noise  was an auditory cue that all was right with the infusion. Infiltrated IV sites never produced the  gurgle. Glass IV bottles had a special place in every nurse's heart. We never gave a thought to their disappearance. What could possibly replace such a dependable and familiar piece of equipment?

The beginning of the end for glass IV bottles occurred in July of 1970. Outbreaks of hospital acquired sepsis by the bacteria  Entrobacter cloacae  were linked to Abbott Labs newly designed glass IV bottles with screw caps. The decades old bottle cap was pealed off to open the bottle similar to a pop tab on a can. Occasionally the metal would peal off unevenly resulting in a problem opening the bottle. A new screw on cap was designed to eliminate the opening problems. There were also problems with spiking the old design caps. Sometimes a tiny portion of the black stopper would break free and float freely in the IV solution. We were always told not to worry about it, but foreign bodies like little black flecks of stopper made every nurse nervous. Who in the world would want something like that coursing through their veins?

The newly designed threaded cap was easy to use and the problematic  black stopper was retired. We all liked the new design, but problems were waiting in the wings that would spell the end for glass bottles.

Viable bacteria gained access to the IV fluid while it cooled following the autoclave procedure which created a vacuum drawing bacteria in through the threaded interstices of the newly designed  screw- on cap. The end result was 412 known infections among hospitalized patients and 50 deaths. All of Abbott Lab's intravenous solutions in glass bottles  were withdrawn from the market in March, 1971.

On May 29, 1973 a Federal grand jury indicted 5 corporate officers from Abbott Laboratories. Investigation revealed the Abbott IV plant in Rocky Mount, N.C. was contaminated with a variety of pathogenic bacteria. The proliferation of bacteria was exacerbated by glass bottles of D5W falling from the assembly line and breaking ( a problem nurses knew all too well)  which provided the bacteria with an ample supply of growth media. This was one of the initial cases of health care officials facing criminal charges.

Hospitals were desperate for a supply of IV fluids and Baxter Labs had just introduced a novel product - IV fluids in a flexible rectangular configuration featuring a plastic container that collapsed as fluids infused. The flexible IV bags were tagged with the clever  name "Viaflex" and the revolution had begun. These bags could be stored in any position and touted a completely closed system-the bags collapsed as the fluid exited. No venting required. With the old bottle system it was risky to piggyback antibiotics into a primary line because drugs like Keflin came in 2 gm. bottles requiring a vent and connecting a vented secondary bottle to a vented primary line could allow for air embolism. Small plastic bags of piggyback medication eliminated the air embolism risk. Baxter acquired a pharmaceutical company and began selling premixed drugs in small 100cc plastic bags. The IV piggy back was off to a running start with the closed system mini-bags.  Soon many drugs administered by IM injection were being given IV and fancy new fangled notions of determining peak and trough levels of drugs evolved.

For a brief time period (1976-1980) Viaflex bags and glass IV bottles assumed  a tenuous coexistence. Vented IV sets were bicultural so to speak and could be used with either Viaflex IV bags or glass bottles. Using  nonvented  Viaflex IV tubing set up on a glass bottle was strictly taboo. Hapless practitioners that pulled this stunt found that without a means to relieve intrabottle pressure the drip chamber collapsed like a lung in a punctured pleural cavity. If the problem was not promptly corrected the negative pressure could begin to draw venous blood through the angiocath producing a tell tale red streak of blood in the IV tubing. Spooky indeed and guaranteed the nurse a prominent position on the wall of shame and vulnerable to endless gossip..."You would not believe what Suzy did with her IV last night...yada..yada," nurses only made this mistake once.

By 1980 the intravenous therapy world was ruled by Vialflex like flexible bags and glass bottles were gone for good. Abbott even began producing their own IV bag that had an unusual feature that nurses disliked. The port for adding medications was a blue bull's eye  target about 3 inches up from the bottom of the bag. When adding drugs to an IV, nurses were used to holding the port in one hand to steady it while injecting with the other hand. There was nothing to grasp on that blue bull's eye and nurses in a hurry were known to poke a hole through the opposite wall of the bag resulting in much cursing and  general unpleasantness.

This transition from glass to plastic  was difficult for seasoned old nurses who by  nature of their basic constitution were resistant to change. Glass bottles had prominent labels and were easy to identify; bags were produced with an over wrap that obscured the label. Drip chambers on glass bottles hung perfectly vertical; on bags the drip chamber was often hanging at an angle. Patient transfers with a bottle always required the careful use of a pole to maintain the positioning of the bottle. Nurses were appalled at the occasional  practice of tossing the IV bag on the patient's lap or chest during brief transfers.  Bottles would roll off and break if this crude trick was attempted. It was easier to thread a solid object like a bottle through an opening for an arm when changing patient gowns. Those IV bags were like getting a grip on a handful of Jello.  Finally, hanging those flimsy bags could be difficult. It was necessary to free up the folded vinyl hanger and thread the small opening over the hook on an IV pole.

I am truly impressed by the variety of realistic sounds produced by electronic devices like that camera shutter clicking noise on cell phones or that  "whoosh" noise when sending an email. The Oldfoolrn  medical equipment design institute has come up with another innovation. How about an electronic IV pump or controller that emits a skeumorphic noise replicating that gurgling noise as a bubble coursing through a vented  glass IV bottle. Lots of old nurses would  truly love hearing  that reassuring noise again.

Fevers - Antiquated Defervescent Interventions

Venerable, old nurses were taught that fevers were a destructive response that required immediate intervention to bring the body temperature back to that magic number of 98.6F or 37C. Since there were few real cures for much of anything back in the good old days, rigid authoritarian protocols, whether they worked or not, were established to control the chaotic world of febrile hospitalized patients.

Temperatures of all patients on the ward were routinely checked first thing in the morning with glass mercury  thermometers. We had one complete class session on the proper way of shaking thermometers down.  It's all in the wrist snap.  Fevers did not follow a rigid time  schedule and could spike rapidly just about any time of the day or night. It was easy to miss fevers with routine schedules because they could rise and fall with reckless abandon within a very brief time frame.

Protocol called for cultures for temperatures over 101F even if the cause was suspected to be neurologic and their was no sign of sepsis. Fevers climbing to that dreaded 102F threshold triggered a series of unpleasant and down right miserable interventions for suffering patients. Denial exists on both sides of the bedside rail and lots of compassionate nurses reported thermometer readings of 101.8 to put a halt or delay to some of the more miserable interventions to drop temperatures. Hyporeportinosis in it's finest glory.

This illustration shows the fight fire with fire fever treatment. That's a teapot propped up on the stand at the foot of the bed. The steam cools as it infiltrates the tented sheets and the nurse is applying ice packs to the patient's head. The thinking (if you could even call it that) behind the steam bath was that it opened pores and promoted a profuse diaphoretic response. From the patient's perspective, I suspect it felt like receiving a hot foot while having your head stuffed in a freezer. Miss Bruiser, my favorite nursing instructor had many tales about patients in steam baths; none of them pleasant. I don't think she ever had a temperature reported as 101.8.

Alcohol sponge baths were another weapon in the armamentarium to battle fevers. Equal parts of water and 70% isopropyl alcohol were combined in a bath basin. After placing axillary and groin icepacks the nurse swabbed the patient's entire body with the alcohol laced cooling solution. The shivering induced by the strategically place ice packs  was bad enough, but the fumes from the evaporative  cooling action of isopropyl alcohol was even worse. I'm certain the shivering and hacking cough produced enough muscular activity to counteract any of the cooling attempts. Some old nurses replicated the experience of greenhouse workers by borrowing misting bottles from housekeeping and spritzing the febrile patient with a toxic mist of alcohol and water.

Introducing ice water into just about any available orifice was another hoary nursing intervention favored by those practitioners with a masochistic vein. Nasogastric tubes were swiftly passed and flooded with boluses of ice water. Miss Bruiser would rest her oversized meat hook of a hand on the patient's epigastrum as the frigid water infused and arrogantly nod her head, "Ahh..he feels cooler already." It was always a mystery to me how she could feel past the barrier of the stomach wall, abdominal muscles, fat, and skin, but it was never prudent to question Miss Bruiser or her whacky methods.

Just about any ailment had a specific enema treatment and fevers were no exception. Febrile patients were subjected to backside buffoonery that entailed ice water enematizations. This approach from the rear did seem to reduce fevers, but I always suspected it was limited to the localized cooling of sphincter muscles when temperatures were measured with rectal temperatures. I always had the notion if Miss Bruiser could catch a glimpse of the patient's misery filled facial response to this frigid intrusion that she would temper or soften her approach to patients. Fat chance of this occurring, Miss Bruiser's field of view was limited to the icy enema tip and it's intended target.

Asking questions of old time nurses about the science behind their crude interventions could land an innocent student in a heap of trouble. Fever interventions were largely based on empirical notions and asking to see supporting data was seen as an indirect way of telling the person they really did not know what they were doing. Both parties full well knew there was no science to support their dubious activities and asking for the data when there was obviously none, was seen as rubbing salt in the wound.

A Scrub Nurse's Prayer

May your Mayo Stand rise up to meet you.

May the Bovie smoke always be at your back.

May the overheads shine glare free upon your sterile field,

and until the skin margins meet again,

may God load your needle drivers with 3-0 silk.

Nursing Diagnosis - An Aimless Pursuit

Your patient suddenly loses consciousness, blows his pupils with a narrowing pulse pressure and
has the beginnings of decerebrate posturing.   What's your diagnosis nurse?

"This patient is experiencing hypovigilance secondary to disruption in the flow of energy resulting in a disharmony of the mind, body, and/or spirit." Say what nurse? Old time diploma students never dabbled in this high minded, academic  activity of  the modern  nurse diagnosticians, quite the contrary, we were sternly advised, "Nurses do not diagnose."  This resulted in many deferrals to "Ask your doctor."

We were well versed in acute clinical contingencies (Ha..Ha...I can talk just like you smarty pants nurse diagnosers) and knew exactly what to do if the patients under our care had problems.
Verigo on arising-back to bed...A hemorrhaging arm laceration-slap a blood cuff on while the resident scrambles for hemostats...Hypoglycemic..Have some orange juice...A sluggish chest tube-milk it.  It's really just plain old common sense.

A bona fide diagnosis is based on objective and measurable data, not the whim of a nurse wordsmith spouting off gobbledegook. The evidence supporting the diagnosis would enable different practitioners to come to the same conclusion. I think that those folks a lot smarter than I call it inter- rater reliability.

Nursing diagnoses grant objective status to subjective information. When subjectivity is confused with fact and treatments based on unfounded assumptions are implemented, bad things can happen such as that infamous 1-10 pain scale.

When nursing transitioned from a diploma based hands on education training to an academic setting, office sitter, nurse big shots had to come up with entities to differentiate themselves. They came up with three humdingers that are indeed, unique to nursing. Nursing research, which, more accurately should be called clinical research if the purpose is to improve clinical care. We don't have doctor research. Nursing theory of which I have written jabbered about in a previous post and finally nursing diagnosis.

These discursive disciplines have one thing in common. They are unique to nursing and difficult for other healthcare entities to understand. If the end game is to be a valuable, contributing member of a collaborative, team effort they fall short. Lots of nurses, especially old fools like me cannot comprehend them so maybe we should drop the nursing from nursing diagnosis and work toward a common goal. Diagnosis that is based on objective fact and guides healthcare workers toward effective treatment.

Nursing is all about common sense and using what you know to directly and appropriately helping patients. Having a nursing life that involves only intellectual and down right incomprehensible material is not a good way to live. Some folks think that mastering complex linguistic feats  and fancy talk is going to make them look smart and sophisticated. Truly smart nurses have a high sense of humility and plain talk that really does help patients overcome illness or mishaps.  .