A Nurse With Attitude

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

Archive for the month “September, 2012”

Veteran vs. Graduate

 A Graduate Nurse throws up when the patient does.
An experienced Nurse gets an antiemetic before cleaning it up the mess

A Graduate Nurse wears so many pins on their name badge you can’t read it.
An experienced nurse doesn’t wear a name badge for liability reasons

A Graduate Nurse charts too much.
An experienced nurse doesn’t chart enough.

A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes.

A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn’t want anyone to know they are a nurse.

A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of her hand or on old napkins.

A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them.

A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse doesn’t hear any alarms (but the critical ones).

A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse only wants to know if the patient is symptomatic.

A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath.

A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse.

A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody.

A Graduate Nurse looks for a chance “to work with the family.”
An experienced calls social services to talk with the family.

A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all.

A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter.

A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.

A Graduate Nurse thinks psych patients are interesting.
An experienced nurse knows that psych patients are crazy.

A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some Advil in her bag.

A Graduate Nurse doesn’t find this at all funny.
An experienced nurse does.



Neuro Day

   Just Some Random Thoughts

Today was a great day.   (Much to my surprise). I got to do some great work with great people.  Usually this time of the year is filled with dread.  I mean,  this is the time of year when med students  suddenly become actual doctors.  They throw them out there for us to deal with.  We teach them to wash their hands, sterile technique, germs and how we don’t like them in surgery.  This is pretty  difficult when you are already simultaneously working on positioning without pressure sores, informed consent, and making sure that what gets done is what is actually what is suppose to get done.  In a nut shell, we’re incredibly busy dealing with the usual stuff , plus teaching all the new recruits.  Just a little fact, because of all this, July and August is the most dangerous time of the year to have surgery.  Finally, it’s getting a little better!

I was in a Neurosurgery room today.  This is my service and we fix Parkinson’s disease and seizure disorder.  We also fix debilitating chronic nerve pain.  Trigeminal neuralgia and spinal pain.  Today we did a Rhizotomy procedure and several deep brain stimulator procedures to make Parkinson’s victims have steady hands.  It was incredibly rewarding to see the patient become tearful to have, once again, steady hands.

Parkinson’s disease is a terrible debilitating disease.

I try to remember that life isn’t fair… but it’s better than the alternative.

Advice; Don’t tell the patient

Yesterday, I was heading off to surgery with my patient and the nurse in the next bay was wheeling hers out too. Except this nurse looked back and said, Don’t worry, he’ll be fine.”  I cringed a bit and kept walking.

Here’s a bit of info that I chocked away in the “strange but true advice” section.  Never, ever, ever give hope or encouragement to a patient unless you are absolutely positive about the outcome.  Only tell the patient the stuff that is quantitative or provable.  If it has anything to do with feelings or anything that can’t actually  be measured… just skip it.  I know that this sounds rather petty, but it can keep  you out of hock.  This is a true story about when I was young and naive.  I was checking in a patient for a routine case. He was having something rather common, maybe like a gall bladder surgery, I don’t totally remember.  His wife was very nervous. I talked with him and his wife at length, explaining every aspect of the procedure and what was to be expected. Eventually the anesthesia staff came and was ready to get him off to the OR.  As we rolled away, she called out, “I love you!”  I looked back at the tearful wife and I said,  “don’t worry,  he’ll be just fine.”  Well, unfortunately that was a big mistake.  Thirty minutes into the procedure, he suddenly threw a clot and had a massive myocardial infarction.  He lived (barely) and we sent him off to the ICU on a ventilator.  My lesson,  never learned… never say  “blah, blah, will be just fine.”  You can never know when the death angel will swoop in and take them away.  Procedures now a days are as safe as going to Wal-Mart.  But you still can get hit by that bus in the Wal-Mart parking lot.  I find it a little ironic, because I live my life day to day.  I mean, I live as if I’m going to die tomorrow. If tomorrow indeed comes and my eyes open up… well, I consider it a blessing,  and I thank God for that extra day. I say a prayer and say, “thank you God, I promise to make the best of this day.”    I don’t know why I could ever think that the angel couldn’t get past Nurse John and steal away my patient.  But sometimes, by sheer fate, it  just  happens.   Because of this, I always tell my patient (and family) the honest truth.  And as a superstition,  I never say that they “will be just fine”  Instead, I say that I “will give him my very best care.”   If they are particularly nervous, I will offer to pray with them prior to going to surgery.  This seems to give them greater comfort and if the unexpected happens, I feel better for it. If the worst happens, I feel that I can give comfort and counseling  post emergency a whole lot easier.”

Oncology Surgery

    I worked with the plastic surgery team today,  and as a special treat I got to spend some time with my favorite Oncology surgeon.  Dr. Pete is not only the best surgeon, but he is probably the smartest person that I have ever met, (on any topic).  Our team was working on an 82 year old woman on Medicare who had breast cancer.  We were doing a bilateral mastectomy and a bilateral take down.  The plastic surgery team was coming in and doing a bilateral rebuild and bilateral breast implant.  We were in the beginning of an all day procedure, that,  in the end, would produce the voluptuous breasts of a 28 year old.

As a nurse, I have a pretty good working relationship with a very large number of doctors of various services.  One of the reasons that I love working with Dr. Pete is that, for a doctor, he is still quite honest.  In my experience, most doctors seem to be like used car salesmen. They will still sell you the undercoating and special seat covers, even if you don’t need them,  just to make a few extra bucks.  Doctors get paid by the procedures that they perform, not by the curative results.  You might not need the procedure that they want to do, but they still want to make that extra cash. You may be riddled with terminal cancer, but they will try to sell you just one more treatment. The nurse is the only real patient advicate in the whole system… but that is another story, on another day.

Anyhow, Dr. Pete  should have been pretty happy that he was getting a huge paycheck for this procedure.  On the other hand, when I asked, he said he was still rather glum.  Being direct, I asked for an explanation. When you’re enclosed in a small room with one surgeon and one sleeping patient, it helps if you can pass the time with conversation, if nothing else, to make the workday more entertaining.  In that, you tend to strike up some pretty interesting conversation to pass the time.  Anyhow, he went on to say that he was unhappy with the health care system as it is.  The new Obamacare plan was just beginning to wield it’s influence,  and some of the changes have not been for the better.

Once I got Dr. Pete to talking, he said that he had a 36 year guy on Medicaid in his clinic. This  guy had a bad inguinal hernia in desperately need of surgical repair. Because of the pain, he was unable to maintain work.  He wanted to get this fixed so he could get back to work and off of the disability and unemployment… but Medicaid wouldn’t pay unless this problem was “life threatening.”  Dr. Pete said, “this guy needs a simple procedure, of which I’d gladly do it for free so he could get back to work. This guy can’t afford the supplies and hospital expenses.  For the price of this single 82 year old, who is getting her procedure paid in full,  and will never pay a thin dime back into the system, we could pay for a lot more.  A simple procedure, and this guy will be back to work and he will be, once again, a tax payer.  For the price of this woman’s procedure, I could do thirty of these guys and they would all be back working and paying for their own procedures in no time.  The system is beyond broken and I don’t know what to do about it.  If I  even knew where to begin, I’m not in any position to do anything about it.  I just know that the current system is not working and I’m frustrated”

I quietly agreed with the surgeon and offered my own conservative bent to his problem, and we went on at the procedure at hand.  I mean, where can I go with that?  I had a renewed respect for doctors in general and I was sympathetic to boot.  Like it or lump it…  in the end and despite all the wrangling done by the conservatives and libertarians alike, I think that the new health plan that Obama has engineered will eventually be the law of the land.  When it hits with all its glory, I will accept it.  We all will be forced to accept it.  I just hope that the majority, who voted this in, will realize exactly what they are getting in their haste to bargain with the devil.


“Politicians are the lowest form of life on earth. Liberal Democrats are the lowest form of politician.” – General George S. Patton


“Liberals are like slinkys. They are really good for nothing but will bring a smile to your face when you push them down a flight of stairs.  – Anonymous

Anxiety Dreams

 If I were going by perception rather than logic, I’d testify that I don’t normally dream at all. I go to sleep, I wake up. That’s all. Sometimes I wake up with vague odd notions, and often with a very strange song in my head. But vivid dreams? Not often. I’ve had chronic insomnia, so maybe I just don’t sleep enough to get that far into the dream  state. Maybe I don’t wake up enough to remember, I don’t know. I accept that everybody dreams and I just don’t remember mine, because that’s what I’ve been told so often and there’s no special reason to disbelieve it.

And of course once in a great while I wake up remembering a doozy. While not exactly recurring dreams, a lot of them are quite similar. I assume I have them when I’m feeling anxious about something.

The general set-up: I’m thrust into some situation where I am in charge of a certain unit with scores of sick people, like after some sort of disaster.  I have maybe two other nurses and they are drunk, or somehow totally incompetent.  I have literally hundreds of patients and only minimal supplies and minimal or incompetent help.  There’s yelling, screaming, and blood splashing  on the floor.  Very similar,  but still unlike the typical Saturday night trauma night when I use to do ER down in New Orleans.  Most of the time, I can’t remember anything. My wife will shake me away and I’m all sweaty and my heart is racing.  I say, “what the heck, why did you do that?”  She will say in an agitated voice,  “you were wrestling around and yelling for a stat portable x-ray… I assumed you were dreaming about work.  I woke you to get you back home again… and your welcome.  I want you to know,   I don’t allow any working off the clock around here.”  She let out a laugh and went back to sleep.  I got up and had some late night corn flakes to settle my stomach.  I guess, instead of trying for the overtime,  I should go ahead and take that day off the next time one comes around.

Hey!  I’m even gonna even  take a three day weekend!

More-On Muslims!

 Well, I haven’t been arrested yet for exercising my first amendment rights in a very tasteless way.  So, here’s some more Muslim jokes.  In the spirit of Jeff Foxworthy’s bit…

You know you’re An Islamic Terrorist if…

You refine heroin for a living, but you have a moral objection to beer.

You own a 3000 dollar machine gun and 5000 dollar rocket launcher, but you can’t afford shoes.

You have more wives than teeth.

You think vests come in only two styles: bullet-proof and suicide.

You can’t think of anyone you HAVEN’T declared a Jihad against.

You consider television very dangerous, but routinely carry high explosives.

You’re amazed to discover that cell phones have uses other than setting off roadside bombs.

You’ve often uttered the phrase, ‘I love what you’ve done with your cave.’

You have nothing against women and think every man should own at least two.

You bathe at least monthly whether necessary or not.

If you’ve ever had a crush on your neighbor’s goat.

source: http://www.jokebuddha.com/Muslim#ixzz26TIaXSis


All-ah Jokes

 It’s Hump Day Humor Day!   In the wake of the Mohammad movie and then the Libyan riots and then the un-Presidented arrest of the horrible offender… I think I’m going to attempt to make my own riot.  I may even get the distain of our President in the act.  In all honesty, I don’t give a flip if some folks get offended, everybody is fair game when it comes to jokes…..It is the American way!

Q. What do you call a Muslim who owns a camel and a goat?
A. Bisexual.

Q. How do Muslims practice safe sex?
A. They mark the camels that kick.

Q. What does Tehran and Hiroshima have in common?
A. Nothing, yet.

Q. What do you call a Muslim who owns 6 goats?
A. A pimp.

Q. What’s the difference between a Muslim and a vampire?
A. At some point the vampire will stop being bloodthirsty

Well, that’s it for now. They come pretty easy.  If I’m not arrested, I’ll come up with some more next week!


Job Interview

  Because our nurse manager has tasked me with getting our new outpatient spine program up and going, I’ve gotten a place on the interview panel. Anyone that comes here with a job application, I get first run. So far, it’s been a real challenge to get spine people. Last week, we got a new graduate from a scrub tech program. I say, what the heck? We can’t seem to get any seasoned nurses or techs, for that matter, I figure we can mold this new guy into a spine-team-dynamo. As a new graduate, he won’t have any ill conceived notions about neuro-surgeons and their tempers, or any other nonsense for that matter. A clean slate. I called all of his references and referrals and they all gave sickly sweet, glowing, wonderful reviews. So, why was I skeptical? He has a background in marketing. Am I being judgmental because of his special marketing powers in promoting himself? I asked the other people on the interview team…”oh isn’t he handsome,” one said in response… and instantly, I knew that I had to be the critical one. Questioning my objectivity, I went to look what other hospitals were doing and what applicants they were getting in today’s market. Here’s some of what I found:

  1. Do you have any questions.  – “What is your policy on Monday absences?”
  2. “If I get the offer, how long do I have before I have to take the drug test?’
  3. “When you do your background check, does public drunkenness arrest count?”
  4. Why did you leave your last job – “I was fired from my last job because they were forcing me to take anger management classes.”
  5. Why do you want to work for us – “Just for the benefits.”
  6. What are your strengths – “Well, I own a bike.”
  7. What are your weaknesses – “Well, I get angry easily, and I went to jail for domestic violence. But I won’t get mad at you.”
  8. “Just for the record, I can’t work Fridays… I mud wrestle that night.”
  9. When can you start – “I really need to check with my mom on that.”
  10. Use three adjectives to describe yourself – “I really hate questions like this.”
  11. Tell us of a time you made a mistake and how you dealt with it – “well, I stole some equipment from my last job and I had to do jail-time for it.”
  12. Have you given your two weeks notice for your last job – “what’s a two week notice,  I’ve always been fired.”
  13. Any questions for us – “Can I have a cup of coffee… I think I’m still a little drunk from last night.”

Well, After my research, I voted in the absolute affirmative.

That was last week.  Today was his first day to orient with me.  After today, I feel pretty good and I’m certain he’s going to fit in very well here!

Vote Democrat, Get a Government Handout

  Why isn’t Romney 10 points ahead?

He should be. Obama’s first term is an abject failure. By the calculus of normal American politics, Obama should be way, way behind. What’s the deal.

John Hinderaker has a theory.

On paper, given Obama’s record, this election should be a cakewalk for the Republicans. Why isn’t it? I am afraid the answer may be that the country is closer to the point of no return than most of us believed. With over 100 million Americans receiving federal welfare benefits, millions more going on Social Security disability, and many millions on top of that living on entitlement programs–not to mention enormous numbers of public employees–we may have gotten to the point where the government economy is more important, in the short term, than the real economy. My father, the least cynical of men, used to quote a political philosopher to the effect that democracy will work until people figure out they can vote themselves money. I fear that time may have come.

It’s not like we weren’t warned.

‘Bread and Circuses’ is the cancer of democracy, the fatal disease for which there is no cure. Democracy often works beautifully at first. But once a state extends the franchise to every warm body, be he producer or parasite, that day marks the beginning of the end of the state. For when the plebs discover that they can vote themselves bread and circuses without limit and that the productive members of the body politic cannot stop them, they will do so, until the state bleeds to death, or in its weakened condition the state succumbs to an invader—the barbarians enterRome.” ― Robert A. Heinlein

Have we reached the tipping point? Do the parasites outnumber the producers inAmerica? Is this why Obama remains popular?

We will find out in November. Until then, I suggest we all pray.

Actually, you did build this

  President Obama – You Did Build This…  Why are we getting so upset over the new uprisings in the middle east?  Why are we  getting so upset over the death of Americans in the Embassy?  I mean when Egypt was having the overthrow of the government and the “Muslim Brotherhood” was coming into power in that country, our President was praising them and  celebrating the “Arab Spring.”  Now it’s time to pay the piper Mr. President.

If this sitting President had even an  small as semblance of a testicle, he would call up the Libyan president (and any other country that we support), and say “you are not getting another single dime of US support as long as you are not able to prove that you are an allay to American interests.  As a matter of fact, we’re going to freeze all of your assets in banks here in this country until you can prove your an allay to the US.  This would certainly turn things around and the governments of these backwater countries would put an immediate halt to this violence.

But this isn’t going to happen.  Not only do we send Hundreds of Billions of dollars to the countries that cause us the most grief, but Obama actually supports this uprising and has  actual Muslim Brotherhood members in his cabinet!

How outraged are you willing to become? It is time for outrage.

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