Did I tell you that I inadvertently called the attending physician on Friday for blood pressure parameters for my patient's Cardizem? Learned my lesson about the hierarchy in a hurry. Yes, in fact, it was totally humiliating. And I'm not sure why, except that I didn't live it down in a hurry... And I did not get the damned parameters.
My mind is longer than any tree's branch.
In the doorway stands the nurse's aide looking frazzled and tired, rubber gloved, holding wipes in one hand, her pager in the other, towels tucked under each arm. Her nurse is consulting with a family member and a doc about discharge of another patient. “Sarah,” says the aide, “I need your help. Please.” The nurse gives her the, “I’m-busy-with-another-patient-I’ll-be-there-soon” look that means she could be there in ten minutes or two hours. Since I am only charting at the nurse’s station I offer a hand.
I enter the room and approach the patient in her bed. “Just turn her over, please” says Therese. So, I roll the patient toward me and Therese begins to clean her. All the while I’m talking to the patient, “You’re doing a great job, Mrs. L… Here, lean toward me… Just a little longer now…” I adjust her weight, moving my right hand from her torso to her leg and realize suddenly that her extremities are really cold. I place my left hand on her back and get my face down in her face. Not breathing. My ears feel red and hot. I scan the patient from head to toe. I look at the aide. She is madly cleaning the woman, paying me no mind. Suddenly it dawns on me: the aide knows that the patient is dead. In fact, I find out later, the patient had been dead for over an hour.
Why the aide didn’t apprise me of the situation upon my entering the room is totally beyond me. Why she didn’t say anything when she heard me talking, and, more specifically, giving instruction to, a corpse, is also a mystery. My theory is that she either thinks I am deeply spiritual, or she thinks I'm crazy.
It’s a strange world, the hospital. It makes me thankful for my deep and morbid sense of humor, finally serving me well.
If you know Bruno S. or even know of him, this* will be of interest. Particularly poignant is his rendering of Mamatschi.
Yesterday I said goodbye to my patient of the past two weeks, a man of great heart.
Thoroughly enjoying Yokai Monsters: 100 Monsters.
Welcome Perseus! (BKA: Percy.) Half dachshund, half chihuahua -- that's a chiweenie to you -- and the smartest dog on the planet.
Agranulocytosis. Dying white blood cells. Since white blood cells principally fight infection, if you develop this form of leukopenia, you're going to be at an increased risk for a whole host of contagions. What we've heard is that there is some cocaine on the market that is tainted with levamisole, an antiparasitic used in cojunction with other drugs for the treatment of cancer. It's also sold otc as a dewormer for livesock, dogs and for freshwater fishtanks. Why it's being cut into cocaine is anyone's guess, but apparently it's not the first time. However this time we have a health advisory.
Upon seeing a fairly drunk man - looking somewhat like Charles Manson but with a more distinct nose - riding a pink and purple ten speed bike, one handed, gesticulating wildly, down Mission street at dusk, he says:
“Classes communicate differently and our social skills aren't the same. Working-class people aren't big on formal introductions and small talk. We use much more body language and humility. Among us, we share a lot of local history and experience, so there's much we don't have to say to each other. We tend to mumble and say 'you know' a lot. We aren't usually talking heads. Self-deprecation is often our way of exercising a work-group, working toward cooperation and trust. It's a very tribal thing. And home. Home is not a street number, not a building. Home is another word for community, for the tribe ... faces, hands, voices, mumbles and shared work.” - Carolyn Chute
Talking with my clinical group this week about different kinds of hospital nursing (team and primary) I picked up from my colleagues' literature review that there seemed to be no qualitative nor quantitative difference between outcomes for the two -- neither in perceived care nor worker satisfaction. I thought the findings were interesting given the proposed phase-out of LPNs/LVNs in California. The data seemed to reflect that mortality, patient outcomes, satisfaction and nursing burnout were undifferentiated, whether four-year nurses worked on their own or whether they worked with the support of LPNs and CNAs. My clinical instructor weighed it differently, quoting one Linda Aiken who reported in a 2003 study, "hospitals with higher proportion of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates." The argument was that LPNs had unfavorable outcomes based strictly on their education.
An interesting article, provided me by The Partner, describes the application of suspended judgment among first-year medical students, wherein patient self-determination is preserved in the face of loss of ability in autonomous decision making via appropriate, designated surrogate. The results are very interesting and an important consideration for all health care providers. It's the conundrum of best interest of the patient, medical judgment or family wishes placed against patient self-determination. As a nurse and 'patient advocate', you think you know what you would do, don't you? It's worth rethinking because it's a very tricky ethical dilemma.
A classmate saw me reading before class this week and asked, "How can you find time to read?"
