DON'T... TELL... *ANYONE*!!!

I curse more than I should.  I laugh at inappropriate things. I think Honey Boo Boo Child is frickin hilarious. I drink to unwind. I like to smoke an occasional cigar. I rock stiletto heels and a low cut dress. I have fabulous friends who are incredibly with it and cool. By all rights, I'm a god damn Paris Hilton with a syringe in my hand. (well, my boobs are better)

My secret?

I'm a nerd.  I read research articles for fun. I read about advances in nursing care, medicine, customer service, business, and the relatively new field of pharmacogenomics. And if there's one thing I love more than reading about all those things, it is talking about it. This isn't new.  In high school, everyone called me the female Cliff Claven.  That hasn't really changed about me.  Maybe that's why I like being a nurse so much.  I have my own captive audience (trapped in a room with me, no less!! :) ) who generally hangs on my every word --and takes it as gospel! haha!

I could stay cooped up all day for weeks and as long as I have a soft chair under my ass and a good book in my hands and/or an internet connection, I'm happy. I do like to hit the party scene once in a while and catch up with friends, but it's a very infrequent thing.  Primarily, I'm an unsocial little bookworm with a penchant for the written word.

Which is why tomorrow, I embark on a new adventure.. tomorrow, I begin the next step in my academic journey.  Tomorrow, I start classes for my RN to MSN bridge program for a Master's in Nurse Administration.

Don't tell ANYONE, but... I'm kinda excited. ;)

My new fave Doc and the "Curse of Dr. Smartass"

There was a standout resident when I was at my first hospital of employment.  Very personable, unpretentious, smart as a whip, and fabulous with the patients. He's now one of our internal medicine docs!! I can't tell you how much we all enjoyed working with him this weekend and how happy the patients were with him.  Oddly enough, he was in the same class as Dr. Super Shitty. LOL

I love listening to him talk to patients. He actually communicates with them more like a nurse than a doc. An example of Dr. Awesome's patient interactions goes like this: "Wow, that sounds really painful, I'm so sorry you are feeling like that. :( How about we try xyz to help with that and if that doesn't work, we have a few other tricks up our sleeves.  Don't you worry- we see this a lot, you will be feeling better very soon.  I promise."  What a joy having him with us and what a stark contrast to his former classmate.  lol!!

In other news, had one of the most difficult patients ever over the weekend. She's a frequent flyer, has been in and out of our hospital every few weeks for several weeks at a time since March.  She has a laundry list of issues, but her biggest issue is that she tortures the staff.  Even worse, she was an RN in a major city hospital in a trauma unit and she is extremely intelligent (has a PhD in nursing) and she's also incredibly demanding. Going into her room is a 45 minute minimum visit.  Plus, she's on contact precautions for VRE in urine, she uses the bed pan (frequently), and she gets 18 pills at 9 am (I'm not exaggerating), plus q8 hr IV antibiotics, q4 hour IV narcotics (supposed to be prn (as needed) but are basically atc (around the clock) ).  She's part Gargoyle (sits indian style perched in the center of her bed surrounded by pillows), part Drill Sargent part Drama Queen. 

Her story is she was exposed to an exotic bird about 10 years ago and contracted a severe illness from a virus that becomes airborne once excreted from the bird. (I am not putting the name of it on here in case someone who knows her googles the virus and sees my blog).  Anyway, she wasn't feeling well for a while.  Saw Dr. after Dr. finally after a few months a Dr. told her to tell him EVERYTHING she did for the past few months.. she mentioned the bird and he ran some tests and it turns out she had it- and several other people she knew were also exposed.  She is on long term steroid therapy due to adrenal insufficiency, asthma, insulin dependent diabetes, unbelievably high blood pressures- even with a slew of BP meds, non healing wounds, spontaneous hematomas, chronic constipation (oh how I love manually disempacting people just prior to a fleets enema- two days in a row) brittle bones that can break from just looking at them (side effect of long term steroid use),  a severely compromised immune system and she gets I   G   G therapy monthly which costs over ten thousand dollars per treatment (Medicare is kind enough to foot the bill for that), I'm sure I'm forgetting a lot, but you get the picture.She'd actually be a great person to give to a nursing student because she loves to talk and teach and because she's extremely complex and understands her specific disease processes very well and enjoys talking about them and answering questions about them.   Most of all she'd be a great nursing student case because it would weed out those students  who can't cut it in nursing pretty fucking quick. 

Here's what it's like taking care of her.

me:  *walk up to her door, begin donning gloves and putting on gown*

Gargoyle Lady: *in sarcastic tone* "Oh, it's time for the pharmacy, again."

me: "it sure is! how are-

GL: "pleasse get this wrinkle out from under my butt.. move this pillow from under my leg, no not like that.. PLEASE just move it UP"

me: "Oh you mean back-

GL: "Yes, UP just like that"

me: "ok, let's get these pills started" *scan wristband* "name and date of birth, please?"

GL: "Gargoyle Lady 666... these pillows aren't right.  I need you to stand them up straight-ohhh my back ohhh my God I can't stand it!!"

me: *move pillows from horizontal to vertical*

GL: *condescendingly* "Nooooooooooooo not like that" *motioning hands vertically* "like THIS" *motioning horizontally*

me: *turning pillows back how they were*

GL: "now stand them up"

me: "so you want me to fluff them a bit?" *fluffing pillows*

GL: "no, I want you to stand them up, yes, just like that."

me: *start scanning pills.  Get about 5 done*

GL: "When you get a minute, I need a box of tissues"

me: "ok" *scanning pills 6 through 8*

GL: 'While you are in here, can you tell me what my hemoglobin was and what my blood pressure as at 3 am when they rechecked it after the IV labetalol?" 

me: "sure, as soon as I'm done scanning these.." *scanning pills 8-10.. 'damn, the prednisone still isn't entered into the pharmacy system, have to manually admin this one in' phone rings.. aide calling to tell me she can't hear the BP in my dialysis patient, I need to recheck it manually.. tell her 'I will go in there next..' scan pill 11*

GL: "ooohhhh I think I need to have a BM .. GET THE BEDPAN.."

me: *put down pills go into bathroom, get bedpan*

GL: "ah that's it.. I sure have a headache I wonder what my blood pressure is right now.  You know you have to check it before you give me my labetalol.."

me: "the aide just checked it 30 minutes ago.."

GL: "It could have dropped too low for me to take it... oooooooooooohhh the pain ah ah!! The bm is RIGHT THERE  please help me get it out!!"

me: "I have to get some lubricant"

GL: "OH PLEASE PLEASE HURRY! AAAHHHHH"

me: *remove gown, remove gloves, wash hands go to supply closet down the hall, get lube, get her tissues she asked for. put items inside doorway of room -

G: "OOOOHHH AAAAHHH OOOOH IT HURTS HURRY HURRY"

me: *cheerily* "okay.. getting gowned up!" *use hand sanitizer, put on gown, put on gloves, put on another set of gloves (crucial step when shithole spelunking)  tie gown, take 2 steps toward bed-

GL: *flatly* "I think I got it" *pulls brown finger out of her own rectum

me: * 'well, that will go well with her breakfast seeing as how she can't walk to a sink to wash her hands'*

GL: "ohh OHHHH there's MORE!! Please help me!!"

me: *squirt lube on double gloved index finger, start coaxing out poo balls*

GL: "aaahhhh AAAAAAA ohhhh DIG DEEEPER! It's right there!"

I will spare you the rest of the story.  Now, imagine 24 hours of weekend spent just like that. 

Oh,  so the Curse of Dr. Smartass?  One day while 3 nurses were chit chatting with Dr. Smartass (actually he was the Dr. that came to talk to the guy with the trach who was driving me crazy two years ago.. I posted about it here: http://codebabe.blogspot.com/2010/07/best-of-best-and-worst-of-worst.html)  about Gargoyle Lady he said (jokingly):

"That's because she was a nurse.  All you nurses end up like that."   

To which my jaw dropped with a combination of disbelief and despise said in a low tone, but quite distinctly 'youuu fucker.."    The combination of his saying that and my F bomb in response pretty much had us all in utter hysterics for about 5 minutes.  Dr. Smartass can be assured, if I do turn into Gargoyle Lady.  I'M ASKING FOR HIM EVERY TIME I GO TO THE HOSPITAL!! lol

How Dr. Shitty always ruins the day: What not to do if you are a hospitalist

My patients are primarily  followed by the the Internal Medicine group with my hospital.  (at my other hospital we had a mix of internal medicine and residents). Sometimes we have a PCP doc with hospital privileges (they ROCK, by the way.  The patients love them and the nurses do too.)

Enter Dr. Super Shitty. King of All that is Wrong with Internal Medicine Doctorin' ™.  When I work with him, I basically hum "I'm an asshole" by Dennis Leary the entire day. (usually something reserved for my husband when he pisses me off, so you know this doc has some serious talent)

What could Dr. Super Shitty possibly do that is so annoying?  Let's see...

1. Rounding on all the patients (usually about 20) between 8-9:30 and telling at least half of them they are getting discharged. Except, he has no intention of even starting any of the med recs or paperwork until after he takes his lunch hour at 1 pm.  Then, while the RNs are doing their 9 am med passes, we are greeted with patients in the process of taking off their telemetry, asking to have their IV sites taken out and wearing their damn street clothes.  Then they get pissed off when you break it to them that nobody goes home until after lunch because that's when the paperwork should be done.

2.  Except, Dr. Super Shitty does NOT start the paper work as promised at 2 pm for those patients, oh no.  You see, he is busy ignoring requests for things like pain meds for people admitted with intractable pain and requests for an order for kayexalate for a patient with a K of 5.2.  Because we really LOVE giving that to people anyway.  Oh, and the order a few hours later to send c diff stool sample on the same patient?  Brilliant.  (and I understand everyone has bad days when things don't happen in a timely manner but this is ALL. THE. TIME.  every time he works. It's at the point now where as soon as I see he is assigned to our floor, I want to turn around and punch out as soon as I clock in) As a result, close to a dozen patients are furious at 5 pm when they finally are ready to go home.

3.  Super shitty also is terrible about communicating with family members- I spend my whole day talking to families about matters I know nothing about and playing case manager too (they are typically on call on weekends). He also refuses to obtain DNR orders from a patient who has a copy of a living will and verbally tells the nursing staff that you don't want to be resuscitated int he event of a code.  The form is flagged on the chart-- all Dr. super shitty needs to do is have the already willing to sign patient sign.. but there the form sits.  All day.
which leads to...
oh yes.
Doesn't the patient code.
And don't we have to initiate CPR.

Thank GOD her cardiologist showed up and said "She does NOT want that! We have spoken at length about this just today. She said she was going to ask the IM doc for the form since he had the chart.. *flipping papers* Why wasn't this signed?!" * flipping more* .. she has severe arthritis and was unable to sign her general consent..  Code babe, you were in the room with me for the conversation, will you witness this?  I'm signing this form as patient unable to sign."  I witnessed it, of course.  I also witnessed a woman's last few minutes of bone cracking chest compressions she didn't even WANT.

The only people I feel worse for than the RNs and the patients on our floor, it's the other internal medicine docs who have to listen to his signoff and then clean up all his messes and put out all the fires he causes. It's a similar thing with RNs.. there are some nurses that habitually don't check labs, always forget to tell you important things and leave you with IV sites that are blown.

So, in sum.  Please, if you work in a hospital, don't do shit like that.  kthxbye

I've been quiet, I know

A lot of things have been going on as of late.  The hospital census has gone through the roof and the average length of stay for each patient is about 1.5 days.  Which means I am constantly doing discharges, getting admissions, and basically chasing my tail at work. Still enjoying my job and my coworkers, but I have found that when I am home I really need to try not to think about work so much.  (as my abused patient entry can attest)

On a personal note, something else has been happening. One of my best friends is currently battling Acute Myeloid Leukemia.She was my first friend growing up and we attended school k-12 together.  We were in each other's weddings. We were pregnant together. Our children played together. She had some flu like symptoms a month ago and they found the leukemia.  She went on to lose her eyesight, develop brain lesions, a fungal infection, becoming septic, then go on a vent. (which she is off of thank God). She's geographically very far away from me right now and it's really REALLY hard for me to wrap my brain around what's happening with her.  This is NOT how it's supposed to be. She's such a beautiful, amazingly talented, incredibly compassionate person.  We are not even 40! This is not how it's supposed to be. 


I don't have very many readers but can I just ask you to please consider getting registered on the bone marrow registry? http://marrow.org/Home.aspx   All you have to do is answer some health questions and they will mail you a cheek swab kit with a SASE   in a few weeks after submitting the swab, you will get a registry card.
Thanks for reading. ♥

He's walking!!!!!!

Remember a few months ago when I blogged about facebook stalking my patients to see how they are doing?  ( http://codebabe.blogspot.com/2012/04/yeah-i-admit-it-i-facebook-stalk-some.html)

He's walking!!! It sounds like he will be able to return to work in August!! ♥

That's all I have for now, just had to share that. :)

Dear Abusive Sack of Shit,

The world does not revolve around you and the way you think things should be.  You aren't the genius you think you are: you are nothing more than a bully and a coward with a narrow view of the world. You look for women who have a history of being abused and you latch onto them and their vulnerabilities like a vulture. In most cases, you chose to be like your father because in your eyes, he was powerful, and he couldn't be hurt.  You learned to secretly hate your mother for her being so weak. You can be an ex con, a chiropractor, a lawyer, a teacher.  No matter what your day job, you are a fucking monster behind closed doors.  For those of you that don't raise a hand to her so you don't think that's abusive: you're an asshole, too. You don't fuck with someone's self esteem and berate them and criticize everything they do and get away with thinking it's okay because you didn't physically damage her.  You hate yourself and you take it out on those closest to you.  Understandable how you hate yourself, you are a disgusting piece of shit.

You teach your daughters to take abuse.  You teach your sons that's how to treat a woman. The repercussions of your fucked up logic and egocentrism laced with self loathing and paranoid accusations over the most ridiculous minutiae make you look like an even bigger fool than you already are.

Just know this, big man:

Every time you hit her, not only her fear but her hatred grows. She becomes used to your torment, desensitized to your abuse. Your constant picking and insulting and demeaning and control and domination is building a fortress within her. Because you see, there's a part of her you can't touch, and that's her spirit.  She may feel trapped by you (by no mistake on your part), but eventually, there's always that possibility that  going to prison won't seem like so bad of an option.  Maybe it will feel even more like a vacation. And it WOULD be a vacation, because prisoners have more rights than she does living with a miserable son of a bitch like yourself.

I remember a patient I had in clinicals for nursing school.  Sweet woman in her 60s in for gall bladder removal surgery.  Sat with her and talked with her for a while and she shared with me that her husband passed away due to diabetes complications just last year.  I said, "Oh I'm so sorry" She said "Don't be. He used to beat me, I hope he rots in hell."  Then she smiled so brightly. :)

Is that the type of way you want to be remembered?  Is that the payoff you seek? If so, keep on with your bad self.

If you are reading this and you see the tiniest bit of yourself in this, do everyone on this earth a favor and get counseling, get castrated and for the love of all that is holy, stay the hell out of relationships of any kind until whatever the hell screw you have loose is fixed. I'm tired of caring for bones you've broken and drying the tears of your victims.

(In case any of you ever wondered why I'm not a psych nurse? This is exactly why.)

How I became a nurse after exactly 1 day of clinicals.

I was in my first semester of nursing school. We were on the oncology floor and we were allowed to "pick" the patients we wanted to research, assess and care for.  I worked on the floor below that one (the cardiac floor) as an aide, so I had some semblance of familiarity with the hospital.  Thanks to that, I was not particularly timid about answering call bells or checking sugars or whatever the RNs needed. The RNs were in report and I asked them if there was a patient they felt needed a little extra TLC for the day. (I chose that approach over "ooh do you have anybody GOOD" with 'good' meaning multiple system failure and tons of meds and labs to learn from) I suppose even from the beginning I've been much more patient focused rather than disease focused.  The nurses looked knowingly at one another and said, "Well.. there is one.. but.. this is your very first semester and your first clinical?" I steadily looked at them and said, "Whatever it is, I can handle it.."

And with that, I had my very first nursing student assignment.  A tiny little woman with inflammatory breast cancer. Her left breast was the size of a football. She was admitted a few hours prior. She was incredibly sweet, a little confused, and extremely anxious.  Her younger brother was in the room with her.  He's lived with her and cared for her for years. He was a little backward, but very nice. He told me she doesn't like Drs or hospitals, and that last month she told him she thought she felt a lump in her breast when she was in the tub. Since he's her brother, he felt awkward asking to see it, but he told her maybe a Dr should look at it.  She said "no no no! If a Dr. sees it he will tell me I'm dying!".  The brother didn't push, and she bathed only twice weekly and kept quiet about her breast after that for a few weeks. Then the day before her admission to the hospital he asked her about the lump and she started to cry and showed it to him.  He called for an ambulance.

Drs came in and spoke with her, wrote for dry dressings to go over the wounds on her breast.  She needed dry sterile dressings loosely applied with no tape.  Why?  Her breast was spotted with black necrotic tissue due to her paper thin skin being unable to stretch with the rapidly growing tumor and the skin split opened and subsequently became seriously infected. (according to the Dr's estimation, the tumor grew from a golf ball to a football size in 4 weeks).

The RN for this little lady gladly gave the reigns to me in caring for this woman after seeing me interact with her..the patient responded very well to me and trusted me completely- much moreso than any of the other professionals who came into the room.

I provided am care (washed her, applied lotions, etc). And then attempted to dress her wounds on her diseased breast. She looked down and really looked at her chest.. and started to hyperventilate. I told her to look at me... I put my hand on her arm. "We are going to cover that up and give you medicine to feel better, okay? Deep breath..relax. I'm with you." There was no way that gauze was staying on her without tape, but I didn't want to tear her skin. So I had an idea... I called the maternity floor and had them tube me those mesh panties they give to new moms.. I slid her swollen breast through one of the leg holes of the mesh panties and slid the dressing underneath. Then I buttoned up her gown.

My instructor came into the room with the RN to admire my handiwork.  Not long after, the hospice case worker and the Dr. arrived to break the news to her and her brother.  She had about a week left, if that.

The news should not have hit me like it did, it shouldn't have surprised me. Luckily, I was out in the hallway when I heard it (and not in the patient's room).  I briskly walked around the corner to the nurse's station. Everything became blurry, my throat tightened. Deep breaths.. deep breaths.. A question entered my left ear "Are you okay?"  it was one of my classmates.  I answered shakily, "She's on hospice.. she's going to die.." And she hugged me.  The RN and my instructor walked over. "Do you need to talk?" I answered, "Not now.. I need to be there for her.  I can process all this later."  I went into her room and sat with her and her brother.

I held both their hands and talked to them about the inpatient hospice facility she would be going to.  How beautiful it is, how great the staff are, etc.   I printed out  a bus schedule for her brother and told him he can sleep at the facility to be with her if he wants.  He liked that.

About 2 hours later, the transport team arrived to transfer her to inpatient hospice. I hugged her and said my goodbyes. I hugged her brother and told him, "Just be with her. You don't have to tell her any magic words, there aren't any. You are giving her the greatest gift a person can give by keeping her from being alone."

I cried heavily the moment the elevator doors closed, her little hand lifting from the stretcher in a final wave of goodbye.

I turned to one of the nurses who debated on whether or not to give her to me and I said, "Maybe I couldn't handle it after all..."  She put her hand on my back and she said, "You handled it like you've been a nurse your whole life.  Welcome to the profession."