Pretty funny...

Lying To Yourself! by TROOP! - Official Sketch Comedy

Add to My Profile | More Videos

Busted without her makeup!

Don't get me wrong! She still looks great, but what a difference a high-dollar makeup artist and hair stylist makes! Of course, if I had her bankroll, I would hire the best in town also. She's young, talented and beautiful.... a triple threat.

Our local recreation department had baseball, softball and soccer leagues are cranking up for the new season here in town. They make it possible for people of all ages to participate. There are groups for 6-8 year olds, 9-10 year olds, 11-13 year olds, 14-17 year olds, men's baseball, women's softball and church leagues. Then there's the grandaddy of them all, the 40 years old and up league. Damn. I'm so old, if I wanted to play in an "organized sport", I'd be playing with them. Now, I do enjoy getting on the field and showing my know-it-all 10 year old a thing or two. (His jaw dropped when I showed him how to hit one over the fence!) But to know that I would be in "that" group!!! It just blows my mind!

Where did all those years go? One minute I was an irresponsible young adult with hardly a care other than to decide what club I was going to on Friday night. And now... now I find myself saddled with bills galore, a job that has become more frustrating as the days wear on, responsibility for making sure my family has food on the table and tons of yard work and house work! Oh what I could have done with the cash if I would have been lucky enough to win last Friday's Mega-Millions! Heck, even a fraction of that money would have been more than enough to make me happy!

Ah, well. One thing is for sure though, I would not want to go back and relive my youth. I DO have a precious son who means the world to me as well as a nice home (even though it works me to death!) I'm also fortunate in that I have a good (though frustrating) job that pays well and I am surely thankful that my family and I enjoy good health! Money isn't everything, and money can't buy happiness although I'm willing to bet it sure couldn't hurt!

So, I guess it wouldn't be so bad to play in the "40 years and older" league. At least I'm still capable of hitting and catching a stupid ball. But I have to draw the line at running the bases! Oh my poor knees! (Although they are feeling better since I have lost 40 pounds since December 6th, 2006! 30 more to go!)

By the way, that's Beyonce Knowles in the picture in case you haven't figured it out!

Spring!!!

My favorite time of year will shortly be upon us! Spring! There's nothing like a change in the weather to perk me up. Winter is so bleak here. All we get is cold, rainy days with some wind to boot. No snow here, so none of the fun that comes with it such as skiing, snowboarding, sledding, etc.

But spring has already begun to show its colors. Daffodils are blooming. Japanese magnolias have been blooming for about 2-3 weeks now. Temperatures in the 70's some days! Great weather for tennis and softball or anything you would want to do outdoors. Well, except for going to the beach or tubing down the Itchetucknee River. I need good hot days for that!

Along with spring, comes a new attitude for me. No more being stuck in the house for hours on end with an extremely bored child. It's time to get out and enjoy the weather and sights. I will be attempting this year to take some pictures of the area I live in to share with you all! So keep checking out my blog!

Just a quickie....

It's been a long week here in the south. Joint Commission at one of the facilities I work at, following my patient naturally. Luckily, for me, he liked my charting and commented that it was concise and clear. Too bad the surgeon wrote MSO4 on the post-op orders for the floor.

The "other" facility I work at wasn't under the scrutiny of JC however, sometimes it can be unbearable with a few of the "strong" personalities that work in the department. Between a certain secretary who believes she owns the place along with the nurses that work in it and the attitude of a few of the nurses themselves, I have contemplated leaving this week.

That, in itself, is a shame. I enjoy working in PACU and normally I would not let someone run me out of a department, but I've had it. It's either them or me. I've heard that someone with "authority" is keeping an eye on the few that are making life difficult. And I guess I could stick around and see what happens, but I don't know that it's worth it.

Oh well. It's the weekend and I'm going to have some fun. Play some tennis, maybe some baseball. I'm definitely in the mood to put a few faces on some balls!

Implications of stupidity....

Take a good look at this picture. Does this remind you of someone? Maybe you think he looks intelligent. Perhaps stern. His eyeglasses perched on the tip of his nose. What are his thoughts? Does he look angry to you?


His picture reminds me of an infamous surgeon that I have had the pleasure (note the acute sarcasm here)of dealing with on several occasions. If I ever have the misfortune of landing in the ER and this guy is standing over me, then I will know that I have died and gone to hell. Alas, if I ever have need of a surgical consult for me or a family member in the middle of the night, I will contact the ER and see who is "on call" for the night.

What has led me to be so wary of Dr. Mad you might ask? He has quite a reputation (and it's not a good one I can assure you) throughout the hospital. One of his patients was scheduled for an AAA (abdominal aortic aneurysm) repair. Before surgery, after insertion of an arterial line and PA catheter in PACU, she became extremely anxious. She stated that she did not want the surgery, she wanted the lines removed and then to be discharged home. Dr. Mad comes in to speak with her as we requested and sternly informs her that she "can have the surgery and live or go home without surgery and die." Meanwhile, all the nurses are screaming inside, "Get off that stretcher NOW, run for your life!!!" She continues to insist upon leaving when Dr. Mad orders another nurse to give her Versed 2 mg IV now. Isn't that considered using chemical restraints? hmmmmmmmmm.....

Well, to make a long story short, Dr. Mad gets his day in the OR and it turns out that Ms. AAA was right. Poor woman barely survives his 6 hour gauntlet. She ends up on a ventilator for a few days in ICU, sick as hell. Finally manages to get off the vent, then is scheduled for (more than one) hematoma evacuation. Ten bucks says he's not her surgeon anymore.

Dr. Mad is also infamous for fem-pop bypasses. Mr. S/P fem-pop presents to the PACU in excruciating pain in his left lower extremity. Nurse Do-good is unable to palpate any pulses distally. No pulses per doppler either. Dr. Mad is summoned and patient's condition reported. He tries to palpate pulses... nope, not there. Attempts to obtain pulses with the doppler... nope, nothing. Tries another doppler.... still no pulses. Calls the OR to bring another doppler. By now all the nurses are silently exchanging the "you can't find it if it's not there" look.

The doppler arrives from the OR. Dr. Mad finally obtains a pulse, a popliteal pulse that is. Excitedly rants for all to hear, "There it is! Those dopplers aren't working! Get them fixed now!" We get Mr. Biomed to examine them and, of course, they are both in perfect working condition.

Mr. Biomed confronts Dr. Mad elsewhere who attempts to show him they do not work by example. Mr. Biomed informs Dr. Mad that there is no pulse at that particular anatomical location, places the probe on his own radial artery and.... swoosh, swoosh, swoosh.. what do you know? It works.

Dr. Mad then tells Mr. Biomed to "go back and tell them that you had to replace the battery or something." Naturally, Mr. B returns with our equipment and the entire sordid story of what really happened.

Dr. Mad did not grace us with his presence for quite some time after that. Perhaps it was the raucous laughter of nurses floating from the recovery room as our dopplers were returned by Mr. B that drove him away. We don't miss his ranting and raving to say the least.

Don't misunderstand please. There are some excellent physicians and surgeons to be found. Just be careful who you choose, it could be your last.


Thought for the day:
If you think nobody cares if you're alive, try missing a couple of car payments.

Revelations....

Greetings to all...

Today I would like to give some insight regarding my personality, just so you'll know what kind of twisted mind you're dealing with. Let me state this bluntly. I'm a smartass. I've been a smartass as long as I can remember. I'll probably be a smartass until the day I leave this world. There, I've said it.

I guess being a smartass isn't the worst personality trait that one could have. Being a dumbass is much worse in my humble opinion. Day after day, I watch dumbasses do dumb things, wondering to myself, are they really that dumb or is it just an act.

Acting like a dumbass has it's perks too you know. Like when you know you've done something wrong and just don't feel owning up to it. Feign ignorance. Claim that you didn't know. Then, if you're lucky, you'll get a long, drawn-out explanation and you can just nod your head, give the obligatory "uh-huh" every now and then. Just think of how you have boosted the ego of the person that you've just fooled into thinking you didn't already know. They can leave feeling all warm and fuzzy inside. You can just leave while snickering on the inside.

But, let me reiterate, I am a smartass. Will I ever be a reformed smartass? Join SA, aka Smartasses Anonymous? I doubt it, however, I have in recent months tried to refrain a bit.

One of my most brilliant smartass statements was after someone came to the recovery room after an open appy (appendectomy). The guy was lying there on the stretcher and all of a sudden, out of nowhere, blurts out, "My dick is hot." I hoped I had not heard that right, so I ask, "Sir?" He then replies, "My dick is hot!"

Okay, now a normal person would have said, "What do you mean by hot?" But not me. Remember, I'm not normal. What do I say? Well, what any smartass would say of course.

I reply quietly, with a straight face while writing in my notes, "No sir. I've already looked. It's not that hot." while trying my best not to laugh. Luckily, after general anesthesia, patients do not have much recall of being in the recovery room. It's a good thing.

Thought of the day:
Never test the depth of the water with both feet.

One heck of a week...

It's been an interesting week, to put it mildly. Before I became interested in the wonderful field of nursing, I had absolutely no idea what these poor souls did. When visiting friends or family in the hospital, I never suspected how much crap nurses dealt with on a daily basis.

Sometimes it's the patient that can drive you damn near batty, but more often than not, it's the people you have to deal everyday. Patients in my unit (PACU) are often sedated with pain medications, sedatives, etc., plus they are transferred to another department within 30 minutes to an hour (if they're stable of course.) Too bad that we can't give our co-workers something to pipe them down too!

Case in point...
CRNA brings a patient in to recovery S/P I&D of infected elbow. Patient has oral airway on arrival to PACU. Respirations of about 6 per minute, SpO2 of 79-93% with jaw thrust maneuver and 10 LPM via face tent. Unresponsive, was reversed at the end of the case. I get report, (while holding his jaw, naturally), and what kind of pain med did he get 30 minutes earlier while in the OR under anesthesia? Why 20 milligrams of morphine....all at once. CRNA *attempts* to leave. Oh no, I don't think so. Insert a nasal airway, opt for a larger OAW, attempt to stimulate. SpO2 is up to 82-92% (still holding that jaw.) CRNA tries to leave. I don't think so.

After about 10 minutes of this, I finally get the guy to give him some Narcan. So he gives 40 micrograms. Mr. Elbow's respirations pick up to around 12, still has OAW and NAW intact. SpO2 92-96% on 10 LPM via face tent. Okay, you can leave now.

Mr. Elbow is arousable now. OAW and NAW discontinued. Respirations deep and even, decent O2 sats, wean his O2 to 2 LPM via nasal cannula. He continues to be somnolent and has one of the worst cases of obstructive sleep apnea I've ever seen, sats are up and down. So, I end up giving him 40 mcg of Narcan times 2. He finally wakes up, (while maintaining more than adequate analgesia), and I can get him off to the floor. And yes, I give a detailed report to the receiving nurse about the entire incident, and caution against the possibility of re-narcotizing.

Two hours later, I get a phone call from the charge nurse where Mr. Elbow has been sent to spend a lovely overnight vacation in paradise. Same problem, though not as severe as it was in PACU. Even though I am not obligated to follow up as this is no longer my patient according to hospital policy, I go upstairs and do it anyway (after all, it is my license.) When asked about his apnea, wife tells me that he sleeps like that all the time, never even thought about a sleep study. The charge nurse has already contacted the surgeon and was unsuccessful at getting an order for Narcan.

My only option is to contact the anesthesiologist on call. Great. I'm sure he'll want to hear this in the middle of the night. Luckily, he's a pretty good old boy. Tell him the story and he asks me if I gave pain meds in PACU (why hell no.) Gives me an order for Narcan IM, continuous pulse oximetry (I've already got it on Mr. Elbow), O2 (got that on too), no IV pain meds (he had dilaudid ordered) and respiratory rate checks every hour. Then he wants an incident report on the CRNA due to the morphine given in OR. (He'll love me for that, I can assure you.)

Anyway, the floor nurses are happy now, they've got the orders they needed. My nursing license is happy now because it's safe for the moment. The anesthesiologist is happy, his patient had a good outcome (even thanked me for going up there to check it out...that's unusual in itself.) Elbow's wife tells me this morning that Elbow's brother informed them today that their father had OSA so bad that he had a UPPP (trimming of soft tissue in the throat.) Imagine that. Elbow was discharge with an order for a sleep study.

There are some great CRNA's out there that are a pleasure to work with, don't get me wrong. But every bowl of cherries has it's pits. Another one brought me a 17 year old with an O2 sat of 17%, get the bag out. (You could see her neon blue lips when she rolled through the door from the OR.) That's a whole 'nother story.

No morphine for you....

This one's dedicated to all the drug-seekers....

Female patient in mid-20s undergoes a simple procedure in the OR, extubated shortly after arriving in the PACU. First words out of patient's mouth were complaints of pain. Not an unusual complaint, after all, she just came out of the OR. However, 99.9% of patients that undergo this particular procedure never complain of any pain whatsoever (no incision involved.) This chick is the other 0.1%. Obnoxious, agitated, demanding and just plain old nasty.

Review of her chart reveals an allergy to Morphine and "Narcotics" without any further specifics. She goes on to state that she is not allergic to morphine, she just has "some itching." Uh-huh. This is going to be good. Patient states that she is hurting and wants to "go back to sleep." I ask her if she has any reaction to Demerol to see what she says. She doesn't even ask what Demerol is and goes on to state that she has no reaction but it doesn't help her "at all." Um- hum...

This particular PACU has standing orders that permit the RN to decide which pain med and how much to give based on patient need and nursing judgement. (I also work at another PACU in which the specific order has to be written by anesthesia before giving any med. That's another story.) So, she's allergic to morphine and "narcotics" therefore, I'm not giving her any. After telling her, "I'll be right back, I'm going to get your pain medicine," I walk to the Pyxis to pull it. Of course, she's watching my every move. I promptly return to the bedside with a vial of Toradol. (Non-narcotic pain med for those that have not heard of it.) She's looking extremely pleased as I draw it up and proceed to push. At this point, another nurse has returned to take this patient because I have another one in the next bed.

She asks, "Was that morphine?"
Me: "No."
Patient: "What was it?"
Me: "Toradol."
Patient: (Screaming) "TORADOL!!!!!!"
Me: "Yep."
Patient: (Still screaming) "I thought you were giving me morphine!!!!! Toradol is useless!!!!"
Me: "I'm not giving you anything that you are allergic to."
Patient: "But I'm not allergic! I just itch!"
Me: "That's an allergy. We can't give anything that you're allergic to."

Proceed to give a full report to her new nurse victim. Patient continues to complain of pain, decides to tell nurse that she will try the Demerol, "even though it doesn't work" for her. Nurse gives 25 of Demerol. Patient has a huge histamine release, redness, itching, whelps...

So, she gets Benadryl IV. States she just wants to go to sleep. Nurse finally convinces her to settle down and close her eyes. Within a few minutes, we have peace and quiet.... finally.

Thought for the day:
It may be that your sole purpose in life is to serve as a warning for others.

Thought for the day....

Some days you are the bug, some days you are the windshield.

On a happier note....

Before you all come to the conclusion that the main focus of my blog is to simply complain about the goings on in the wonderful world of medicine and the like, I'm going to try to redeem myself here. I have had the pleasure to work with some of the most professional, courteous doctors and nurses imaginable.

Here's my "gratitude" list for docs (in no particular order):
1. Thank you for your patience when explaining or showing me how to carry out your orders when you requested that I do something I've never done before.

2. Thank you for not being short (or worse) with me on the phone in the middle of the night when I had a concern with your patient or needed to report an abnormal lab value.

3. Thank you for getting up out of your chair to assist me with a combative patient when you could have sat there and waited on someone else to do it.

4. Thank you for picking up the phone and ordering that CXR when I was the only one in the unit and the patient was critical.

5. Thank you for calling to check on your critical patient and giving me the opportunity to voice any concerns rather than telling me to call the "on-call" doc if I have any problems.

6. Thank you for taking the time to learn my name and then addressing me by it whenever we meet.

7. Thank you for realizing and acknowleging that I am doing my best for you and your patient. I can't control how quickly the lab gets your results back to me for those stat labs or what have you, but I appreciate the fact that you are not blaming me for their shortcomings.

8. Thank you for asking my humble opinion about your patient and his condition. It's nice to know that I'm thought of as a colleague with a brain, not simply as your hand-maiden.

9. Thank you for writing legibly so that I don't have to call a staff meeting to decipher your orders.

10. Thank you for returning my page promptly. If it wasn't important, I wouldn't have called you.

All in all, we are a team, you and I. Like a well-oiled machine, we work best when all the cogs are lubricated and fit into one another as a hand in glove. I need you and, like it or not, you need me. There is nothing more rewarding than working with a doctor that you have respect for and that respects you. It makes all the difference.

Okay, enough of that mushy crap...

Here's my thought for today:
"It's always darkest before dawn. So if you're going to steal the neighbor's newspaper, that's the time to do it."

Stupidity....

Had a great time playing tennis today with Son. What a wonderful way to "let go" of the agression that has been eating away at your insides. I'm most aggressive when bouncing the ball off the wall. WHACK!!!! WHACK!!! Ahhhhh, nothing feels quite as good as hitting the ball so hard that your teeth feel the impact. What does this have to do with stupidity?? First of all, it has to do with my own stupidity for renting my MH to my in-law (see previous post.) More importantly, it has to do with the stupidity of some of my co-workers. This includes nurses, CNA's, doctors, lab technicians, radiology techs.... and the list goes on.

First story to come to mind is one that happened a few months ago. Patient had a thyroplasty due to a paralyzed vocal cord. Of course, there are airway concerns due to the procedure, but this was even more so due to the gentleman's size. I'm talking nearly 500 pounds of barely breathing flesh here people. O2 sats are sucking (anywhere from 75% to 96% on 10 LPM humidified O2 via face tent) but the guy is alert and oriented. So far so good... Ask our aide to get me a trach tray, better safe than sorry is my motto. After questioning me about it, I finally get my point across and she gets the tray. So, I keep the guy in PACU to watch him for about 45 minutes or so. O2 sats improving (anywhere from 86-96% now.) He meets criteria for discharge to day surgery so here we go.

I push the (heavy) stretcher back to his day surgery room, hook the O2 up as ordered (see above) and proceed to give report. As a general rule of thumb, I always review the MD's orders with the receiving nurse. So the orders state "ice chips only until I re-check." What does Nurse Stupid do?? She asks the patient what he would like to drink! Even offers him Coke, Diet Coke, Sprite, juice, etc. I am astounded!!! The patient's wife is astounded!! Needless to say, the nurse was promptly corrected.

Another case of blatent stupidity occurred when Nurse Dummy gave a 2 month old infant a bottle of pedialyte in the PACU right after GI surgery. Boy, was that MD ticked off. (He had a right to be.) He made a huge scene in the PACU in front of all the nurses and the patients! Even the patients had looks of horror on their faces when they saw the tantrum he threw. (I think he would have been better off the have addressed the situation in a different manner as one of the patients was his very own. She couldn't believe that kind old Doctor would act in such a terrible fashion.)

To wrap this post up, maybe Doctor should imagine Nurse Dummy's face on that tennis ball and whack the crap out of it. I know I put a few faces on my tennis balls today!

Ever seen anyone with this expression?

I certainly have. I've seen this expression on many a face... doctors, other nurses, patients, or worse... the patient's family...

I've seen it on members of my own family including Husband, Son, and even (hanging head low here) myself. This is actually the expression I have worn for the most part of the day. Why? You might ask? Well, let me enlighten you. Sometimes it is not good to try to help an in-law out of an unfortunate financial situation. You can be repaid with the said in-law going out on the town enjoying life while you are working extra shifts to pay not only your own bills but to also try to keep a roof over their heads as well. Lesson learned.. never rent to in-laws! At least the in-law is not living under the same roof as myself! Okay, I'm through whining about this, moving on...

Patients.. for the most part I actually enjoy taking care of my patients. Pain control is one of our main concerns (after the ABC's you know.. airway, breathing and circulation) in the PACU, or Post-Anesthesia Care Unit. Morphine, Demerol, Dilaudid, and good old Phenergan (Versed if you've been very bad) can be a nurse's best friend. With the right combinations of these medications, you have the ability to significantly ease almost any pain imaginable. It's absolutely wonderful to be able to help someone in a time of crisis. Of course, there is the occasional crack-head, drug abuser or what-have-you that no matter how much pain medication you give them, it isn't going to help! Then they have the audacity to accuse you of not giving them any meds even after you have explained the reason that they are continuing to have pain.

One good thing about working in the PACU is the fact that visitors, as a general rule, are not allowed in the PACU. We are simply too busy extubating patients, monitoring the ABC's, taking care of vent patients, etc. to have family members asking questions or making demands on our precious time. The bottom line here is that the PACU is a critical care unit such as any other ICU. We are here for the patient first and foremost. Problems do arise when family members cannot understand the rationale behind it being a closed unit... they get the "expression."

More to come...

Playing nice...

Greetings all...

After reading many blogs by other health professionals, I have been inspired to start my own so that I may share the many insanely stupid events that I have had the strength to endure. No, I'm not kidding. Working in the PACU (aka the "recovery room") can be a rewarding, yet crazy, experience. You have the ability to help your fellow humans at a time when they need it the most. Some patients are great, others not so great... Some coworkers are great, others not so great.... some docs are great... well, I think you get the idea. Bear with me as I get this blog up and running. Feel free to comment any time the urge strikes....