Portrait of the Scrub Nurse As an Artist

Yep...I hijacked the title to this post from that great Irish literary genius, James Joyce, whose near blindness probably enhanced his writing ability by excluding extraneous stimuli. Operating rooms, on the other hand, have loads of stimuli, but they are certainly nothing to look at. The stark, tiled walls and hard unforgiving terrazo floors almost call out for beautification and just about anything  aesthetically pleasing is a huge step forward.

Scrub nurses have a variety of artistic media available to them right on their Mayo stand and  each individual has their own style. My attempts were crude compared to some of the Rembrandt like efforts of today's youngsters.  I'll give a brief account of my lame efforts and then morph into some truly beautiful work by contemporary artists scrub nurses and scrub techs.

My initial  artistic endeavors involved cutting various designs in my sharps bag which was really nothing more than a plain old waxed brown paper container. A straight Mayo scissors was the perfect cutting tool and I began with profiles of hearts on the sides of the bag. After all, any operating room could use a little more love.

 As my skills advanced, flowing scalloped edges inspired by the Rococo school of art adorned the top of my sharps bag. Ratcheting a needle out of my driver and dumping it  in the sharps bag had a new found feeling of artistic fulfillment as I watched it drop past those lovely scallops. Simple pleasures for simple minds.

In the 1970's the hottest new innovation in surgical draping was a material called Vi Drape which was nothing more than a sheet of polyurethane with an adhesive backing. After prepping, a sheet of Vi Drape was applied to the skin and the surgeon made his incision smack dab through the Vi Drape. No cutting corners here!  The idea was to isolate the skin from the surgical site to prevent infection. Vi Drape also provided a sterile platform for plopping an organ down on it without fear of contamination.

Before the skin sutures were thrown in place, the Vi Drape was pealed off and unceremoniously tossed in the ever ready kick bucket. While removing a used Vi Drape from the bucket, I noticed how the overhead lights illuminated it, creating a stunning design. The center of the drape that had been incised glowed like a twinkling star and it was surrounded by a lovely pinkish glow thanks to the retained Zepharin prep solution. Pink tinged Zepharin was certainly more pleasant to look at than the yucky brown Betadine prep which is so ubiquitous today. The speckling added by blood droplets and minitissue chunks highlighted the brilliant center of the design.

How could I display this masterpiece? The answer was no further than an unused light box used to view X-Rays in our break room. I archivally preserved my masterpiece by sealing it in unused Vi Drape and secured it to the light box. There was mixed reaction from my fellow nurses. Some loved it while others thought I was nuts. Art is supposed to get folks talking and asking questions so I fulfilled my purpose.

Now for the good stuff. Orthopedic surgery provides whippersnapperns with a great media for sculpture, namely bone cement. Marjorie RN at bloodgutsandcoffee on Instagram has some really great work displayed on her posts. The sample on the left has even been enhanced with what is apparently Methylene blue and a surgical marking pen. How cool is that.

Orthopedic surgery also provides for brief "time snacks" while portable X-rays are taken. What a perfect time for artistic endeavors. Every moment of pseudo leisure can be put to good use in the OR. Sculpting with bone cement is surely lots more fun than gazing at that yucky blood/bone chip slurry reposing at your feet.

When I was a youngster, surgical marking tools were limited to a tooth pick and a medicine glass filled with methylene blue. To mark an area the tooth pick was dipped in the dye and dabbed in place, a crude method which did not lend itself to intricate designs or sketches.

Today, it's a different story. There are all sorts of surgical marking tools that are not only useful in marking patient's skin, but also function great as a means of artistic expression. The canvas is a surgical towel or mayo stand cover. Surgidoodle on Instagram has some of the most intricate and lovely designs I have ever seen. This "circle of time" is one of my favorites and the way the tips of a pair of Babcock clamps  point directly to the serpents head is really spooky. Maybe someone is about to snag that serpent in the jaws of their Babcock and free that omniscient eye lurking in the center. Who knows!

Surgidoodle also has a simply elegant work on her Instagram page titled SHARK ATTACK. You won't get any of that artsy fartsy sillyspeak from me on this magnificent work. It's simply beyond description. The contrast between the stark line drawing of the attack with the severed lower extremity and the ambiguity  of the bloody mottled background make us consider the complexly entangled lives we lead in the OR. Heavy stuff, indeed.

Shark Attack has all the elements of  a quintessential work of fine art: A life altering event frozen in time, the sometimes random element of trauma infliction, how trauma dissociation is based on evolutionary survival behavior, how invalidated trauma generates silent internal screams,  and an inquiry of the survivability of traumatic injury. The assorted components cohere into an elegant whole that transcends the harsh, unforgiving environment of the tiled temple. Compared with the wan, self involved art (I'm thinking of the Andy Warhol Museum here in Pittsburgh,) which strain for undeserved and unearned profundity, Shark Attack is in a class by itself!

If I have piqued your interest in operating room artists here is a listing of some of the ones I enjoy on Instagram.

ortho_artistry features some very nice bone cement sculpture work

operatingroomart shows us some lovely abstract images created by a urologist with a cystoscope and gel.  Absolutely more colorful than a meatotomy!

surgeryboxcartoons shows what can be done with a surgical head covering container.

And of course surgidoodle which is my all time favorite. Thanks for inspiring me to finally get around to posting something. 

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Downey V.A. Hospital Signage

Dr. Scott Mastores is  a graduate of  Chicago Medical School which was constructed on the Downey VA Hospital grounds shortly after I quit working there. Thankfully, he rescued this sign from the trash and was kind enough to Email it to me to share with all those interested in Downey VA hospital.

There were lots of interesting signs at Downey and this one was on prominent display in the lobby of most of the buildings. I don't think many of the patients bothered to read them and enforcement was lax. Most of the nurses at Downey would much rather have patients lying on the floor than fighting on the wards.

Just about every ward had a pool table and a sign that stated throwing pool balls was prohibited. I broke up an unusually nasty altercation where two patients were bayonetting each other with pool cues and was promptly advised there was no signage prohibiting this activity. "If we can't throw poll balls at one another, what are we supposed to do?" was their response.
 

Boo Hoo

 Lots of views, but no comments and I'm stuck in a terrible brain freeze. I'm open to any suggestions for a post. Thought about an updated nursing awards post if I can crawl out of this cognitive abyss!

Stick 'Em Up

 

 

                                    "That's the last Bicillin shot you're ever going to give!"

Student Nurses Learn to Smoke Cigarettes

"All right it's time to break up into groups of two. The smokers will demonstrate
 to the non-smokers how to light up and inhale a cigarette. Return demonstration
is required and I don't want to hear any of that gagging or coughing!"

 Every  hospital based nursing school had a class motto. In my school where Miss Bruiser, my favorite instructor presided, the old adage was;  A journey of a thousand miles begins with a single step. Initially, we thought  this slogan referred to breaking down an arduous accomplishment into simple steps to achieve our final goal of receiving  that coveted pin, but after nearly three brow beating  years and constant harassment our assessment shifted. A thousand  miles was along way from home and diploma nursing education transported us to a bizarre new world with strange new rules and customs. Professional adjustments was our very last class and we were going to learn how to conduct ourselves as nurses in this strange new land.

Miss Bruiser, regal and pompous like a queen, strutted around the classroom with her cap serving as a crown. Her edicts were delivered sternly in the same tone one uses to discipline an unruly child or train a dog. It almost felt like she was deploying little bombs in the back of our heads, set to detonate sometime in our future nursing life.

Miss Bruiser  harshly intoned, "The first order of business is going to be the  use of tobacco products. Every nurse should learn how to smoke cigarettes in order to connect and relate to patients, especially on the psych wards where it's an absolute must and I don't want to hear any of your lamentations or sniveling. If the smoke bothers your throat do what I do, smoke menthols or don't inhale!" ( Hmm...I wondered if Bill Clinton was a nurse in a previous life, that "don't inhale" business sounds all too familiar.)

The finer points of cigarette smoking included the proper use of ash trays and cautions about letting the ash get too long. Never aggressively flick an ash or use a cigarette to gesture which might give the wrong impression. I never could figure out the rationale for those two rules, but like many other things, there were many mysteries in nursing. The rule about holding a cigarette between the index and second finger made sense. In Chicago only gangsters held their cigarettes between the thumb and index finger.

The opening lecture about smoking set the tone for the entire course. It didn't much matter what your personal feelings or wants entailed, you were going to be a nurse and it was way too late to question the rules. We got what we set out to get and that was the only thing that mattered.

Money was always a hot button issue in diploma nursing programs as alluded to in a previous post, we were not even allowed to carry money because it simply was not needed. The school met all your needs from food, housing, books, and uniforms.

 The third rail in any nursing job interview was inquiring  about salary or compensation. Instant death to anyone foolish enough to ask. Nursing was not meant to provide practitioners with financial stability, but you won't ever be broke and you do eventually learn to navigate desperate situations with your pride intact.

 Asking for or charging other nurses money for  just about anything will rot your pride. I think that's what makes me cringe when I hear whippersnapperns asking for payment for online education or commercial products. I realize we are in a brave new age but I'll never get used to nurses asking other nurses for financial compensation. It makes me very anxious because it makes me feel like bad things are coming and I can almost hear Miss Bruiser's howls in the background.

Working at a charity hospital highlights the unfairness in the world and careers that earn a good bit of money were seen to exacerbate the inequalities in society. Despite the financial precarity of a nurses salary there was a unique kind of ecstasy in helping those in dire straits. The overly productive lifestyle of folks with money begins to appear pointless. So instead of a class on retirement planning or investing we were conditioned to live with very little.

Although diploma nursing school did have a cognitive constipating curriculum, there were life lessons if you could see past the smoke screen. Miss Bruiser's notion of sacrificing every thing for patient care was not sustainable. A nurse's notion of self care has to extend beyond a break for a Coke and a smoke. I think whippersnapperns have a much more realistic notion when it comes to self care.

The lesson that really stuck with me was that it really doesn't require much money to generate happiness and well being. Some of my happiest days were spent in a crumbling third floor apartment with my Raleigh bicycle parked in the hall.

Lucky for me, I really never got the hang of that smoking business. If I had been a successful smoker, it's unlikely I would have survived to become an OldfoolRN!

Practice makes perfect!

Do Nurses Do Windows?

 Yep! Old school nurses were window cleaning experts and I'll let you in on a secret method to make those panes glimmer brighter than a new graduate's nursing pin. Impress your grumpy old instructor and win brownie points galore. So much more fun than dealing with that balky hopper in the dirty utility room, smells a heck of a lot better too!

Step 1: Sprinkle a dash of baking soda on a gently used and lightly moistened ABD sponge. Rub the baking soda on the window and don't be afraid to add some gusto (just like the nurse in the illustration.)

Step 2: Go over the entire window with a plain, wet ABD. Central supply is usually more than happy to provide ABDs that have reached the end of their service life. One thing that does not work well for window cleaning is old, worn out student nurse aprons. I think it has something to do with all that imbedded Argo starch impeding absorbency.

Step 3: Mix equal parts water and vinegar in a spray bottle and mist the window.

Step 4: Buff aggressively with a dry ABD and stand back to admire your work. Just think what a wonderful world it would be if all things in nursing could be as fulfilling as window cleaning. Instant gratification at it's very finest. Cleaning windows sure beats scrubbing emesis crusted beds.

The Daring Ortho Patient on The Flying Trapeze

 

"Get that needle outta my leg or that doc on  my right with
the glasses gets clobbered by a flying trapeze!"

                           

  Modern hospitals have become disquieting places without the time worn cues to orient folks to the  type of services available on a particular ward unit.  The ortho wards look naked without beds fully encased by unwieldy traction frames and their sundry attachments. 

Respiratory floors were easy to spot with their huge "U" tanks of oxygen wheeled about by tired looking nurses and orderlies. Now everything looks the same and  the appointments are more expensive than can be easily afforded by the common man.

Fancy in the wall pipes did away with the huge oxygen tanks scattered wily nily about the ward, but lack of orthopedic framework and their ever present trapeze was a move in the wrong direction. Living (if you could call it that) tethered to weighty  traction inside the confines of  an orthopedic bed was an unpleasant patient  experience to say the least,  while outside, in the untethered world, the healthy danced the tune of their small delights. In todays vernacular, orthopedic traction and it's accompanying long term confinement was a huge patient dissatisfier.

The underbelly of the miserable world subsisting below the  ortho trapeze always reminded me of a steaming jungle  teeming with rank smells that bubbled with hot gasses vented from inside an overheated, sweat infused hospital mattress. Patients confined in nasty conditions like this clamored for attention and soon learned a trapeze was better than a call bell for eliciting attention from nursing staff.

It's a sad truth,  most of our nursing forebears had seen way too much suffering to be easily moved by a patient's plight. Patients strung up in restricting traction soon learned that like the porcupine's belly, the weak spot for just about any hardened nurse was a struggling patient.

 So struggle they did. The key to attracting a friendly nurse to the bedside was timing, as the target nurse passed by the always open door, the hapless patient wildly swung by one extremity from the dangling trapeze as if he were about to crash back down to the stench laden  mattress in a fatigue induced heap.   Who in the world could turn their back on a struggling patient?  The "helpless dangler, about to crash gambit," worked on just about every nurse. It was a sure fire way to garner some attention, if even, for a brief moment.     

Wily traction bound patients had the luxury of lots of time on their bedridden hands to come up with more sinister uses for a trapeze. It didn't take much ingenious thought to weaponize an overhead trapeze. Aside from a direct assault by swinging the trapeze at a victims cranium like the poor soul in the illustration above, the pull and shriek strategem was equally painful, but more subtle. 

Nurses tending to orthopedic patients frequently had to work below the dangling trapeze when performing painful procedures like cleaning indwelling  traction pins  with hydrogen peroxide  pins or administering stinging  injections. The ortho patient's  golden hour of returning the painful favor to the nurse was when her cap and/or hair brushed against the chain securing the trapeze bar. A quick downward thrust on the horizontal trapeze would lock the nurse's hair in the trapeze suspension chain. The end result was a hair pulling event upon the nurse's pained departure. I think this is one of the reasons that orthopedic nurses were the pioneers when it came to abandoning the traditional nursing cap. A clump of scalp hair suspended from a trapeze bar was a chilling sight.

Most everything encountered in the nursing world has a yin/yang aspect to it, and trapezes were no different. Trapezes could do good things as well as cause trouble. Orthopedic patients were ordered to wear TED compression hose at all times as a clot prevention measure. Most all life threatening clots formed in deep veins and compression hose only worked on superficial vessels. I could never figure out how such an ineffective intervention could gain widespread use, but that's fodder for a future post.

Patients soon discovered the trapeze was an ideal suspension device for drying newly laundered hose. Just hang the TED hose over the horizontal bar and PRESTO they dried in nothing flat in the steamy hospital environment. Enterprising patients also discovered the trapeze was a great place to suspend photos of loved ones. Having a treasured family member in line of sight worked wonders for patient morale.

The pendulum like back and forth movement of a trapeze was also great for inducing a calming effect. The rhythmic swing tended to induce a peaceful hypnotic sort of state that helped counteract some of the misery induced by immobility.

I recall one patient who discovered a truly novel use for a trapeze. The ends of a trapeze were open and the void made a convenient place to ramrod cigarette butts. Old hospitals were chock full of smokers on both sides of the bedside, patients used the trapeze ends for an ash tray and nurses were known to use the traction support holes in the footboard for cigarette disposal. 

Head Nurse Annie confronted one of the nurses about finding KOOL cigarette butts in the traction receptacle and was countered with a good defensive point, "But I smoke Winstons," the wizened nurse replied.