Foolish Photos

I found some old photos in my basement that unfortunately lacked captions. Here is what I came up with.

Miss Bruiser, instructor at the school of nursing admonishes one of her charges. "Stop snickering Kathy, I said occipital, NOT ox spittle."

"Yikes! His chest sounds like a Maytag on the rinse cycle"


 

Student nurses at The County welcome 2 victims volunteers to the nursing arts procedure practice lab. " Today we are doing continuous bladder irrigations. Who wants to be first?" the eager nurses inquire of their hapless "patients. "

"With this new universal scope we can visualize any body cavity through any orifice. When positioning, just be certain to have the correct end of the patient up in the air. Oh, and don't forget to apply a liberal application of Surgi-Lube to the business end of this baby."






 

A Linen Closet as Fine Art

I stumbled upon this illustration on Google images and it immediately grabbed my attention.  The fact that it was not currently copyrighted meant that I could use it  which seemed enticing. From the way the shadows cast by the folded sheets create a  3D quality to how the lighting is done to give the nurse an almost ethereal quality really is just fascinating. The photographer must have had a light source within the linen cabinet.  A spectacular view of a really ordinary place.

I learned this photograph was taken in February 1943 by a well known industrial photographer, Robert Yarnall Ritchie. One of his main interests was aviation and aerial photography, but he illustrated a variety of other subjects.

Not surprisingly, this was commissioned by a linen mill, Pepperill Manufacturing at Saro  River Falls in  Bradfford,  Maine. The company was named after Sir William Pepprill a Maine soldier and industrialist. There primary product was sheets and blankets and production was ceased in 1949.

We used to make up "bed packs" and stack them at right angles to one another for easier handling just like the photo illustrates. A bed pack consisted of two flat sheets (fitted sheets were not available), a draw sheet and a pillowcase. The bedpacks were meant to have everything necessary to make a complete bed. The "loose" linen was on the other side of the closet and consisted of individual items like towels, washcloths, and separate sheets.

The hospital where I trained frequently experienced an uncertain supply of certain  linen items. We sometimes would run out of either towels or draw sheets. This prompted  nurses to create  top secret   secondary linen closets in unexpected locations like under sinks in nurses bathrooms or in patients cupboards. It was not unusual to reach for a bottle of IV fluid in the supply room and have a cascade of  drawsheets come raining down. Old school nurses  would do anything for the comfort of their patient even if it wasn't "according to Hoyle." We were always doing something for a patients well being and prefacing the intervention with the explanation  "I know it's not exactly according to Hoyle."  If there was something we could do to  make a patient more comfortable, it was done.

Another nice use for a linen closet was as a sort of meditation chamber to collect your wits after something catastrophic jangled your nerves. Having the walls lined with acoustic dampening linen made the closet a very quiet place even on the busiest of floors. For the full benefit turn out the light, and you have a very peaceful, quiet place to collect your wits before the next disaster unfolds. There are plenty of washcloths to mop up tears so let yourself go.

Linen closets were also an olfactory oasis in a land of putrid, nostril burning smells. The sweet, clean smell of fresh linen was a stark contrast to typical hospital odors. This always worked out well. Most foul smelling events like massive code browns made a trip to the linen cabinet mandatory. It was common to linger in the linen closet and take time to "smell the sheets" before facing unsavory olfactory events. Linen closets really could be the pause that refreshes.

Decades ago linens did not ever travel far from the hospital. There was no contracting out of linen services and everything form laundering, folding and preparation was done right in the hospital building. Our hospital laundry was located in a separate building right smack dab in the middle of a U shaped hospital complex. It was easily identified by the constant output of white clouds of steam. When the linen was worn out it was repurposed into rags or things like scultetus binders. Linen never left the hospital.

I find myself gazing at this photo for long periods of time and really appreciate Robert Yarnall Ritchie for creating such a beautiful image from a different time.

A Tangle of Tubes and Wires

I just know you whippersnapperns have it much more complicated today because I could not even venture to guess all the parameters that you monitor in ICU.  But I bet we have this in common, Don't you just hate it when a new patient is admitted to the ICU directly form the OR?  The anesthetist rattles of a quick report and then quickly heads back to the tiled temple.  You are left with a  rat's nest of wires, tubes, and who knows what else all balled up somewhere on top of or beside the patient.

It's tough to know where to start, but at least you know how a cat feels playing with a couple of balls of yarn simultaneously. This is really a job for more than one nurse. You can draw straws with a couple of discarded needle caps to decide which nurse gets to do the wires and who does the tubing. Wires are  usually the easiest task unless there has been an intra-operative EEG, then both tasks are about equally daunting.

Patience is the key and be sure not to yank on anything to free it up. Try to prioritize, get that arterial line and EKG wires hooked up before you free up that Foley drainage tube. That way you can watch the monitor go wild if you put too much traction on the Foley. At least you know the patient is beginning to react after anesthesia.

This problem is not unique to contemporary whippersnappern's. As this old photo from the late 1940's (that was even before my time!) shows, it requires 5 students and an instructor to untangle this ridiculous hodge-podge conglomeration of tubing and who knows what else. In my time, we would have received demerits for failing to draw the curtain. That spectator gawking in the bed to the left is probably not HIPPA compliant.

It's nice to realize that some problems in nursing remain timeless and serve as a sort of glue to spiritually unite us through time.  These nurses from yesteryear are faced with the same untangling dilemma as nurses today. They might not be dealing with a line from an intracranial pressure screw, but nonetheless go about their task with the same diligence as today's nurse. The sense of caring is always present in nursing.

 

 

 

 

 

Downey VA Hospital..... A Lost Empire

Decades ago VA Hospitals were divided in 2 camps, General Medicine and Surgery or GMS and
Neuropsychiatric or NP. Downey was an NP  faciltity  and the countries largest VA Hospital at 1800 beds. It was located about 35 miles north of Chicago adjacent to Great Lakes naval training center. It was constructed right after WWII and designed to provide a lifetime of care via institutionalization for people with chronic mental illness. There was even a full scale medical hospital with ORs and critical care units with strange names (critical care units were called GPUs or General Purpose Units)  The OR was always called EOR or emergency OR. God forbid anyone should mistake them for a "real" medical surgical hospital. That is the only rationale I could deduce for the funny names.

It was really a self contained city with it's own zip code, 60064. There was a movie theater, bowling alley, golf course, swimming pool, and various work areas for the patients such as the spoon factory where patients spent the day tossing plastic spoons into plastic bags. There was a greenhouse where the most common activity seemed to be digging compost and also a metal and wood shop. All the buildings were connected by underground tunnels which always reminded me of catacombs, with poor lighting and spooky dead ends. Staff moved from building to building topside whenever possible.

Patients were housed in multiple 2 story brick buildings with 2 wards on the first floor and 2 on the second with  total census of 104 patients n each building. Windows were covered with vertical iron bars. There were no elevators and the stairwells had imposing walls of cyclone fencing through the middle core to prevent patients from jumping. Radiators provided heat and there was no air conditioning. The buildings were like brick ovens in the summer. Open windows had no screens and various birds and flying insects entered the buildings. Electricity was delivered by underground lines which were not very reliable. Building 66 where I worked was once without power for 3 days. We used flashlights and battery operated lanterns as a backup. The patients barely noticed, but there was definitely a Halloween atmosphere with bizarre shadows and spookiness throughout. The souls of over 100 schizophrenics all in one poorly lit area.  Yikes, get me out of here!

Almost every patient had the same diagnosis (SCU) or schizophrenia, chronic undifferentiated. About 2% of the population was bipolar and added some spice to the mix. All patients smoked constantly while in the dayroom producing a dense ever present haze. Smoke Eater machines mounted on the ceiling did little to clear the air. A typical ward included the day room with connecting hallway to the dorm which was just a huge open room with beds. Just off the hallway was a restraint room with four heavy beds bolted to the floor. The beds were usually all occupied. My claim to fame at Downey was teaching a couple of very violent patients a self restraint technique. I got them to the point when they felt like slugging someone to come to me and ask to be put in restraints. I readily complied with their request and let them decide when they should be released. It worked like a charm for a couple of patients and I always thought I should have received some kind of performance bonus for my idea. The VA was always handing out bone head awards of one type or another, but I got passed over.

In the mid 1970's things began to change at Downey. When liberals and conservatives have common objectives, things happen in a hurry. I really hate political labels and politics in general, but the liberals thought chronic psych patients needed to be freed from the chains of custodial care and some thinkers like R. D. Laing even questioned the whole concept of mental illness. According to R.D. "Insanity was a rational adjustment to an insane world." The conservatives did not like to spend tons of tax dollars on what seemed like a lost cause. Downey began to change. Long term patients were discharged with terrible end results. Patients wreaked havoc in the community by strolling into restaurants and failing to pay. Camping in city parks and the homelessness we still witness today.

The "Downey" name was first changed to "North Chicago VA" then "Great Lakes VA."  The Chicago Medical School built a huge campus smack dab in the middle of the golf course. Today Downey is gone for good replaced by the James Lovell Federal Health Center. Real medical stuff without EORs or GPUs.  I tried Googling Downey and nothing even came up. I guess some things really are best forgotten.

An Old Nurse Poem

I found this old poem on printed on our graduation program and thought it was clever. There is no author listed




Like an angel hovering near,
Shielding us from doubt and fear,
Face so gentle, sweet and bright,
Like a moonbeam in the night.

Ever constant through the day,
Fearlessly you go your way,
Seeing that no one grows worse....
Heaven bless you,
                         Faithful Nurse

Terrific Terrazo Floors

Terrazo floors were common place in old hospitals, found in halls and heavy foot traffic areas like operating rooms. They were created by mixing small stones, usually of different sizes, in a dyed concrete mix. The mixture was then  poured into forms that were cross-hatched with metal dividers spaced a couple of feet apart.

After the concrete set, the floor was ground down with progressively finer discs on a big grinding machine that resembled a super heavy duty rotary floor polisher. The end result was a very beautiful floor surface that resisted stains such as betadine or blood and lasted practically forever.

As a youngster I had the opportunity to talk with workers installing a new terrazzo floor in an operating room. They were Italian (Terazzo means terrace in Italian) and they were a proud, hard working group of men. The process was very loud and dusty from the grinding down of the concrete stone matrix, but they actually seemed to enjoy their work. The end result was truly a work of art. I am sure the cost of doing this today would be astronomical and I suspect this is the reason terrazzo floors disappeared.

These are two beautiful examples of a terrazzo floor with a silver metal dividing strip down the middle. Our operating room had much darker terrazzo floors with a greater diversity in size of the stones and beautiful gold dividing strips.

In the foreground is a very nice illustration of a terrazzo floor in an older operating room. Notice  how the ceramic tiled walls and terrazzo floors combine to create a certain ambience.  Important things are going to be happening here. These are hallowed halls.

I have seen plain white flooring in contemporary operating rooms heavily stained a yucky yellow color from the prep. A dirty looking floor in the OR does not inspire confidence. Plain looking flooring looks like it belongs in an airport or school, certainly not in a sacred place like the tiled temple of an operating room.

Now for some foolishness. A typical scenario for a scrub nurse on call would be to awaken to a call in the middle of the night stating,"There has been a multi vehicle accident on Lake Shore Drive we need you in the operating room ASAP." I would jump up out of the call room and run to the scrub sink and begin my scrub and  about 10 minutes later I was ready for showtime with my mayo stand set up and my back table loaded for bear. I was chomping at the bit and ready for any thing. Let me at 'em.

Now for the fun part. Sometimes we had to wait up to an hour before the patient arrived in the OR. I really don't know all the reasons for the hold up, but suspect it had to do with stabilizing vital signs and establishing an airway or further diagnostic studies. Peritoneal taps to evaluate internal bleeding were common before CT scans became available. Sometimes the poor soul died in the ER before even making it to the OR.

Dr. Oddo, my favorite neurosurgeon, frequently reminded us that in our line of work it was important to have diversions and relax when you have the chance. He was a really affable, pleasant man  outside the OR with lots of good friendly advice. His diversion was a sailboat docked at Montrose Harbor where he spent much of his spare time.

One of the most important times to stay loose and relaxed was during that wait for the trauma patient to arrive. I would stand between my Mayo stand and back table, guarding their sterility, then begin meditating on the beautiful terrazzo floors. It was a lot cheaper than a sailboat. Once Dr. Oddo observed me deep in my meditative trance and said "How nice, Old Fool was praying." I didn't say anything to contradict him, but I was really exploring cosmic frontiers in the terrazzo floor.

These  floors could be like exploring the solar system if you studied them closely. You could easily identify the planets from the different sized stones imbedded in the floor. For more visual props, distant galaxies like anesthesia can contribute things like yellow tops from KCl multi dose vials to represent the sun. Does Mars have water that could support life? According to that pool of I.V. fluid that was just dripped onto the floor, it does.  Wow is that a meteor shower? Nope, just the lights being reflected through anesthesia's IV bottles.

Staring at the straight gold dividing lines and comparing them to random round stones always made me wonder why there are no straight lines in the natural world. Those straight metal dividers always reminded me of the big straight incisions and what a contrast they were to soft round organs and tissue. Were we doing the right thing here?  I also sometimes wondered if all those little stones in the floor were symbolic of the rocky recovery faced by some of the unfortunate victims of trauma. Life can change in the blink of an eye.

Wow things are getting out of hand here, it sounds like a catastrophic meteor shower out in the hall. Nope, it's the arrival of our patient attended by a band of frenzied care givers. As Dr. Oddo would say, "Let's hit it!"

Scrub - a - Dub

I once got into a heap of trouble because I mopped the floor before cleaning the bed frame. The correct procedure  was to scrub the bedframe free of  stalagtite - like mucous formations  and blood, then proceed to the floor mopping. We were also supposed to damp dust all the flat surfaces in the room, but our instructors only checked the top of the door frame. The moulding around the top of the door was always meticulously dusted.

Before performing this advanced floor cleaning skill, we practiced in the nursing arts lab. Our instructors frequently reminded us of how lucky we were that we did not have to shovel coal into the boiler as they did. We always referred to an older nurse as a "coal shoveler."  It was a badge of honor in that it defined a really tough, experience nurse that could be counted on to do anything for her patients.

Another part of cleaning a patients room was to scrub the ashtray. We had round metal ashtrays with a spring-like device around the circumference to hold the cigarette. The spring had to be removed from the ashtray and all signs of ashes scrubbed out.

We did have environmental service workers janitors to clean the common areas, but the patient room or ward was strictly the nurses' responsibility.

Another rule required the nurse to clean the dietary tray and dishes if there was emesis present on the tray. Student nurses sometimes argued unsuccessfully that the food made the patient sick and dietary should do the clean up.

I always liked that strong disinfectant smell when we were done. It meant our clean up duties were complete and we could learn more advanced skills like sharpening needles