A Nurse With Attitude

Where Dark Cynical Humor, Nursing Issues, and Politics Seem to Merge

Archive for the month “December, 2011”

Just a FYI

Hey,  If you’re following this blog, I’m working on the “hosting my own” kinda thing. Eventually I will discontinue this blog when my own gets fully up and running with all the add on’s and perks that I want to have.  It may be several weeks yet, I don’t know.  Anyhow, If you’re a follower of this, and suddenly find yourself all dark, depressed, empty, and think that life just can’t go on because you can’t get the update… wait!  You can still get my material by going to the new site:  ANurseWithAttitude.com

In the meantime, I will do my best to keep this one up to date until my new site is perfect.

John’s Predictions for 2012

Sorry I can’t be cheerful and upbeat all the time.  There seems to be bad things going on in the world, and with Obama’s current track record backed up by the line-up of clowns posing as Republican candidates I seen no end in sight.  So with all this in mind… here’s John’s Predictions for 2012.

1.        Israelwill attackIran

2.         More Middle East countries will come under radical Islamic control.

3.         Several European countries will experience a financial default.

4.         There will be widespread racial and class strife / riots in America (The Occupy Movement and class warfare stoking during the Presidential campaign)

5.         The U.S. Economy will slip back into a recession and likely move rapidly to a depression state.

6.         America, through Obama, will not provide strong support to Israel in it’s decision to attack Iran. Many thousands of Jews in Israel will die.

7.         Newt Gingrich will win the Republican Presidential nomination due to Middle Eastern turmoil.  Gasoline will top eight dollars a gallon.

8.         Christians worldwide will come under widespread attack

9.         There will be several successful terrorist attacks inAmerica

10.       There will be severe restrictions on American civil liberties in the wake of civil unrest and terrorist attacks

11.       U.S. unemployment will surpass 10.0%

12.       Inflation will rise to 10%

13.       There will be several attempted political assignations inAmerica

14.       President Obama will remain President through 2013 via the suspension of the November 2012 elections.

15.       The current Mayan calendar cycle will end in December. The world unfortunately won’t.

Happy New Year!

More Liability

I made mention of the potential liability issues in relation to giving your total trust to a physician or your nursing administrator.  As an operating room nurse, I am the “gatekeeper”.  For example, a patient can come through the ER, be admitted to the ward, go to pre-op and then get checked for surgery.  If the consent isn’t just so, or there is a family heirloom earring that is somehow lost along the way to the operating room… well, it’s the O.R. nurse that takes on the full brunt of the liability.  I say, “what about all of those nurses along the way that had some sort of pre-op check list to do, or the ER nurse that had collected and bagged the valuables… doesn’t matter a wit. I’ve been told several times, “but you’re the gatekeeper.” Last week I had two Russian brothers in my pre-op.  Brother number one,  “Isaac”, spoke no English at all. Brother number two, “Asimov” spoke only broken English.  The problem before me was that both brothers smelled of vodka.  Both brothers had gotten into a fight earlier that same evening and somehow miraculously made up.  However while in the heat of the disagreement, Asimov had pushed Isaac down onto a running table saw and now Isaac is being prepped for surgery.  He is sitting up in my bed with no clue as to what’s going on while bloody bubbles come out of his three inch deep chest wound with every breath. I walk up and see the surgical attending and resident using Asimov as the “interpreter” to get informed consent for this procedure. I immediately protested and both surgeons were aghast with disbelief.  “You need an official hospital interpreter for this”, I say,  “How do we know what this brother is saying?  He might still want this poor sap dead, for all we know.”

The attending says, “he’s a nice enough guy… and he speaks Russian… he’s got to go to surgery ASAP, so, what’s the problem?  I’m calling the nursing administrator,  you’re endangering this patient”  he said rather smugly.

I said, “are you and anesthesia team both willing to declare this an official level one emergency case?  At least that way we can bypass the whole informed consent thing all together and just rush on back to the trauma room… well?”

They looked at each other a few seconds,  “well, no… we can’t say that this is classified as a must go right now emergency…. You can get your interpreter.”

We were not even ten minutes later in getting to the OR.  Crisis and liability averted and the patient did just fine.  It may not have amounted to much, but you need to really pick your battles in case things go south in a really bad way. Be the best patient advocate because no one else will. Just remember, would you want this to happen to your brother, mother or loved one?  If not, then stand and fight the good fight.

Nursing Responsibility

It’s December and we seem to get more than our quota of GI bleeds around this time of year. I guess it’s because the colors are so festive… Bright red and dark green.

A vague abdominal pain in a 27yo female on who is beginning her menses is not an emergency. She may think it is, but it is not.

Unfortunately, there is just no reasoning with crazy people. It’s “if you can’t see me in the next few minutes, I’m calling ______!   (Fill in the blank with any political official from the current  hospital administrator up to Barack Obama).

So, In the years I’ve been an ER nurse, I’ve had my share of people complaining to management about me.

Once a woman complained to my manager that I was racist, because I triaged three pretty sick patients ahead of  her mildly sick 6-year-old son with a runny nose and sore throat. There was a 78yo with crushing chest pain; a 32 yr with a GSW to the back at diaphragm level with sats at 66%; and a 62yo man with new onset altered mental status and severe weakness on the left side. The funny thing was that all of them were the same race.

Then there was the “dance instructor” with fibromyalgia who also had a “past history” of IVDA.  She wrote a detailed complaint letter because I wouldn’t let her go home with her hep-lock in place so that she could “self-dose.”

All of these I can understand, to a point. People are feeling sick and worried. They’re not at their best, and are unable to see past their own personal needs at that moment. But the latest one took the cake… for now.  I’m sure something else will eventually come along to top this. It always does in this profession. 

I frequently question the trustworthiness of hospital management. However,  I still maintain a vague sense of naive optimism when it comes to, what I call, “doing the right thing.”  As long I know in my heart, I’m doing what’s right for the people involved, somehow I will be protected from ridicule and especially, liability.  Of course, this is complete and utter fantasy-land.  Everyone knows that management will throw anyone, even one of their own, to the dogs to save just one dollar, or especially to save a potential liability. Doctors are just a tiny click above hospital management when it comes to trustworthiness.

I’ve had my run-ins with doctors.  Unfortunately, new nurses tend to get into the worst trouble early in their career simply because of their blind trust for both of these groups.  Everyone just thinks that the doctors are there for the patient.  They even have a doctor club chant of “do no harm”.  This seems to occasionally go on hold when it goes against their income potential.  Now, I know I’m sounding a bit cynical, but don’t get me wrong, some doctors are really good and earnestly want to do the right thing for the patient.  Unfortunately, most want to make a buck.  Most patients don’t realize that they make their money by “doing stuff” to the patient.  It’s like the used car salesman trying to sell the undercoating or the extended warranty.  I learned this right off working at a radiation therapy clinic.  We dosed people with heavy, DNA altering radiation and billed them a large amount for a tumor on their neck when everyone knew that they already had metastatic cancer to the lung, liver and pancreas. They were dying and we were milking that last dollar for everything it was worth.  Our treatment was quite expensive and did nothing toward their benefit except maybe giving a tiny bit of false hope. Some counseling and hospice care would have been far more kind to these people.

When the Air Hits Your Brain: Tales of Neurosurgery

This writer is a bit more cynical than I am, however it is strangely true.  He somewhat unfairly groups all doctors into two groups. A: The one who does procedures only to make money and B: the one who does the right thing for the good of the patient.  Doctor B will talk with the family and recommend what is needed. He is not that popular nor does he make a huge amount of wealth. Doctor A competes with himself as to how fast he can do any given procedure.  He can have a pediatric patient die on the operating room table at three and still make his five O’clock T-time.  In real life, I work with both doctors almost daily.

New, altruistic nurses need to take warning, when there is an argument, the hospital administration will side with the doctor. Especially with Doctor “A”.  Regardless of ethics, the doctors bring in the money, and the administration really loves that revenue.  So as much as it may darken your soul, you need to really pick your battles.

I got into an argument with a resident recently because they wanted to put in a chest tube.  I said “hey, take a step back and really do an assessment.  Do not get mad at me because I won’t witness your consent. The person you want to stab with a chest tube is not some big healthy 20-year-old kid. It’s a frail 70-year-old lady. Although she looks pretty  healthy, even with a pneumothorax.  But she doesn’t speak a word of English and even I can understand that she’s scared about what you’re wanting to do. Please don’t be mad if I grab one of our attendings who happens to speak the same language…  (as the object of your chest-tube lust).
“Come on, let’s get it done… this old gal is tougher than you give her credit for” he says. “You do know you can’t get informed consent using hand gestures not even if your patient is nodding and smiling politely.” How about let’s get a consult with your attending, Please, I insist.  Really do an assessment this lady, she’s stable, her O2 sat is 99% and is not complaining of SOB. She can certainly wait until your attending gets here.”  The resident insists and I use my last card,  “I’m not signing or witnessing anything.”  I say in my sternest voice. He storms off.

I feel that the bedside nurse is the one and only patient advocate in the health care system.  The patients are depending on us to stay current in our practice, be up to date and give the best advice. It’s a huge job, but I feel that I have to do my best for my patient.  It’s the only way I can sleep at night.

The shift eventually comes to an uneventful end.  No deaths, no lawyers, no serious complaints. I give report and head out the door.

Management calls and leaves a message on my machine begging me to come in “for any part of tonight…any part…a few hours, that’s all…please…I’ll make any deal you want…  All your weekends off next month? Anything! Call me please… beep”

I’d consider it, but I just worked five 12-hour shifts in a row. I’m beat, and I’m already in my comfy clothes on the couch with a beer a pizza on the coffee table and Robot Chicken on the DVD. I’m not getting up.

Merry Christmas To All, Even A-hole Atheists

Every year it seems we go through the same crap with atheists and liberals wanting to get rid of Christmas. I have never understood why atheists and liberals would get so worked up over a holiday proudly celebrated in America since America was founded. But, then again, I has never understood atheists or that mental illness called liberalism. I have come to the conclusion that liberals and their ilk are just miserable bitter people who hate American traditions, as well as America itself.

I always get a kick out of everyone saying “Happy Holidays” to me these days. I always reply “Merry Christmas.” So far, I have never had anyone get offended. I would really be surprised if anyone did get offended. Then if it happened, I’d say “Merry Christmas, a**hole!” I have Jewish friends who aren’t offended if I wish them a Merry Christmas and I, in turn, would not be offended if they told me Happy Hanukkah. Hell, I might even go in for a Happy Kwanzaa. But I’m just a big diversity-embracing kind of guy!

What all this comes down to is the usual political correctness where everything American is bad and everything not American is good. In PC America, we must honor every goofy or stupid foreign culture of every foreigner who has ever invaded us while falling all over ourselves apologizing for our own culture.

I’m tired of being told I have to feel guilty or bad about being an American. Because I don’t, Never will. I’m not an African-American, German-American, Polish-American. I AM an American.   I am proud of my country. I’m a patriot. I believe our culture and country are better than any other culture or country in the world. I won’t apologize for it. The last thing I’m concerned about are foreigners and their opinions about America! I was born here…they came here. What I think is way more important than what they think when it comes to American culture and values.

Same goes for enemies of Christmas.  This country is a Christian country founded from its beginning with Christian values. If Christmas offends you, then stay home and think about “tolerance and diversity.”  Or study that mantra you keep feeding us Christian Americans respecting your sensitivities.   Because the vast majority of Americans celebrate Christmas and the birth of Jesus, no one forces Atheists to go to church or pray. No one forces them to pay any attention to Christmas or even celebrate the Christmas holidays. And since the vast majority of Americans are Christian, don’t make a fuss over a nativity scene at Town Hall. It’s not hurting anything. If atheists are offended by a nativity scene or Christmas tree, they can just walk away,  much like the atheists expect me to walk away and be mute when I see a crucifix suspended in urine displayed as a tax dollar funded “art” display.  Plant an atheist tree or watch Star Trek or whatever it is you atheists do through the holiday season. Nobody will care. Just leave Christmas alone!

I’m about ready for America to be for Americans again. Foreign cultures? Don’t care.  Atheists offended? Don’t care.  I’m going to enjoy my freedoms and won’t apologize for anything. Offended? Kiss my patriotic American butt, And , oh yea, have a very Merry Christmas!

100.012%

Well it’s official now.  Those idiots in Washington, those who claim to be representing us “regular citizens”  have officially done it.  TheUSGovernment Debt is now larger than the entire GDP.  We will soon be totally bankrupt or worse, the once solvent, once greatest country in the world, theUnited States of   Americawill be owned operated and governed by the Chinese.

Total Wreck

Total Wreck

Sat noc 2330:  Just another day in the trenches as an OR nurse

It was a disaster from the start.  Our star neuro surgeon suddenly decided he needed to do surgery.  It apparently early in the afternoon.  The patient was already said to be “a little addled” but pleasantly confused.  Then he became irritable and over the next two hours became withdrawn, then somnolent. By 2200 he was unarousable.  The neuro team did an assessment and decided he needed a “decompressive craniotomy.”

Why, why, why. Why would you do a craniotomy on a patient with liver cancer that has metastasized to the pancreas, both lungs and brain, especially when the patient has made it perfectly clear he did not want treatment and had made himself a DNR.

So what happens? Well, first you waste a whole bunch of blood products from the Red Cross, then you continue to bleed until the stress and declining hemoglobin causes a strain on an aged heart.

So here’s the rational to coding this patient:

His disease process didn’t cause this.

We intubate, push meds, do CPR (break some frail, cancer-stricken ribs), shock numerous times, push through all the algorithms until all of the residents and interns have had their fill…

And he dies a terrible death. Like the cancer that ravished his body wasn’t enough. He was someone’s father, uncle, husband.

Merry Christmas… I want to cry.

Quote of the day – Plundering

Government is the great fiction, through which everybody endeavors to live at the expense of everybody else.” – Frédéric Bastiat

Even back in 1850, Bastiat did a masterful job of explaining “legal plunder” but try and explain it to your average liberal democrat and watch their eyes gloss over.

Hallelujah !

At a million-dollar San Francisco fundraiser, President Obama warned his recession-battered supporters that if he loses the 2012 election it could herald a new, painful era of self-reliance in America.

http://abcnews.go.com/blogs/politics/2011/10/obama-if-we-lose-in-2012-government-will-tell-people-youre-on-your-own/

“The one thing that we absolutely know for sure is that if we don’t work even harder than we did in 2008, then we’re going to have a government that tells the American people, ‘you are on your own,’” Obama told a crowd of 200 donors over lunch at the W Hotel.

A government that tells the American people “you are on your own!” Finally. Now that is hope and change I can believe in!

 

What was that?  Oh my gosh, finally a breath of fresh air for us Libertarians. What could possibly be wrong with a little self reliance? What could possibly be wrong with advocating a little personal responsibility?

Seriously now. Can you believe the ego on this guy? If we don’t have Obama, we are “totally on our own.”

Don’t Brag

Just a little lesson about karma….  Don’t brag.

I got to work a little early the other day and the pre-op nurses had two sick calls and were having a difficult time.  I offered to check in a few patients and start the IV’s.

Patient: I’m a hard stick. Only one person has ever gotten my IV the first time.

Patient’s Spouse: That’s right. They always end up calling someone to put the IV in.

Me, after putting the IV in on the first try: Just so you know, I’m the one they call.

 

I missed twice on the next patient.

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