Career Path: Engaged

My daughter, JoJo, just finished her first semester of Nursing School (it's an ADN program) with a 92%. Incidentally, yes, I'm proud!

I asked her if she had decided on a career path. Her response:

"I want to graduate, then work in the ER, because you see everything. Then I want to join the Peace Corps, then go back to school and get my BSN and Nurse Practitioner."

Sounds like a plan to me.

Just Because It's Christmas.....

.....we will rescind the DNR/No Code Blue order on the chart of your bed-bound-post CVA-unresponsive-90 year old grandmother.
Just for you.
Merry Christmas!

ED Christmas Carol: Working Christmas

ED Christmas Carol: Give Them Geodon

ED Christmas Carol: It's The Most Miserable Time Of The Year

ED Christmas Carol: Working On Another Christmas Day

ED Christmas Carol: Do You See What I See

ED Christmas Carol: Freddie The Frequent Flier

ED Christmas Carol: 'Tis The Season

Well, it's that time of year, again. So to help 'celebrate' the season, I'll be posting some Christmas Carols - Tex Style!
I'll post some favorites (my favorites, maybe not yours) from last year, plus a few new ones.

Elvis Has Left The Building...But Tex Is Still Here

Madness has opined about what I might look like, and she was only off by a little.

Here's my real picture:

Actual, Honest To Goodness Order Written In Chart

I shite you not, this was written on an alcoholic patient that came in for a surgical procedure, after the procedure was completed:

2 beers PO STAT, NOW

then one beer PO QID PRN

When you come to the hospital these days, insurance will pretty much just pay for what your there for, so lets not have any these "withdrawal" issues.
We can't afford it.

Calling The Kettle Black

I worked in the Neonatal ICU, again recently.
One parent looked at me and asked one of the female staff:

"You let men work in here? Does he know what he's doing?"

This parent asked the question.

Sweetheart, I've taken care of more babies than you'll ever have (I hope).

ED Sing-a-Long: (Every Patient) Knows My Name

Cell Phone Ringtones and the Dying Patient

If your elderly family member is dying, and you and your family are at the bedside, and if numerous family and friends are call you for updates, support or maybe even kind words, please put your cell phone on vibrate, or at least change the ringtone.

Or maybe I'm the only one that realized that "When The Saints Come Marching In" is a funeral dirge.

Rational Though Process

Recent conversation with patient NPO secondary to CVA

"If you don't give me food, I'm going to have another stroke, I'm gonna die and it will be all your fault!"

Thumb-tastic Ability!

In the age of Playstation, X-Box and text messaging, you would think that eventually this particular skill would be utilized by a patient:

Rapid Thumb Movement

RTB is the ability to flex the thumb up and down at a rapid pace.

I recently cared for a young man who used this skill to press the button on his PCA pump 186 times in one hour.

For those not mathematically inclined: 3.1 times per minute, or once every 20 seconds

Despite repeated attempts to educate the young man in the proper technique of PCA use (less is more, and more is less), he refused to heed.
So instead of getting a max of 10 doses an hour (1 ml q 6 minutes), he settled for 3 doses that particular hour.

Our moral:

RTM may work on PlayStation, but it don't do dick for a PCA

Happy Thanksgiving

May your stuffing be tasty.
May your turkey be plump.
May your potatoes and gravy be without lumps.
May your yams be delicious
And your pies take the prize,
And may your Thanksgiving dinner
Stay off your thighs!

An ICU Conversation...

Tex: Mr. Smith, you didn't eat your lunch.
Mr. Smith: It has onions, and my chest is hairy enough
Tex: Excuse me?
Mr. Smith: Onions cause hairy chests. I learned that in prison.
Tex: A hairy chest is a hereditary characteristic. You get it from your parents.
Mr. Smith: But my dad didn't have a lick of hair on his chest.
Tex: Maybe you got it from your mom's side of the family.
Mr. Smith: She didn't have any hair either.

Makes me wonder what else he learned in prison.

Parenting Fail: The Beginning

Every so often, I get to float to the Neonatal ICU. I used to enjoy the change of pace (and weight) of my patients, but lately it seems the majority of the babies are Methadone/crack babies.
It's heartbreaking when a baby cries and can not be consoled.
But it makes me downright pissed when a baby shrills and cannot be consoled.
Not pissed at the baby; pissed at the mother.
Well, last week I worked the NeoICU, and overheard a conversation.
The mother acted lovingly, interested, and worse, knowledgeable about Methadone and weaning from narcotic addiction:

Neonatal Nurse Practionor: Your baby is progressing fairly. We've weaned her down to 0.26 ml of Morphine every three hours.
MethMama: (holding fussing, crying baby) I think she needs a double-dose. Whenever I get irritated because they're weaning my Methadone, I take a double-dose so I can calm down. I think my baby needs a double-dose.
NNNP: That's not an option.
MM: And why not, it works for me.
NNNP: Because your baby would likely stop breathing.
MM: Don't you have machines for that?

To paraphrase Todd (Keanu Reeves) in Parenthood:

"You know, you need a license to buy a dog, to drive a car - hell, you even need a license to catch a fish. But they'll let any uneducated, drug-abusing idiot be a mother."

When Life Throws You Lemons....

I took care of an unfortunate young man recently who had, to say the least, a sucky year.

Back in January, he began having some intermittent chest pain. A stress test showed some ischemia, so he had an elective heart catheterization.

There is only a 10,000 to 1 chance of having a complication warranting emergent open-heart surgery while having this procedure.

He was the one.

While attempting to deploy a stent into coronary artery, the angio-balloon got caught in the stent. The Cardiologist was unable to deploy the stent, nor remove the catheter.

Although his in-hospital post-operative course was unremarkable, he developed a wound infection a few weeks after discharge.

He followed up, like he should, but the pain in his incision persisted, despite antibiotics.

Eventually, he was re-admitted and put on IV Vancomycin. After a week, he was discharged to home-care with IV antibiotics for 6 weeks.

In late May, he was finally well enough to go back to work, where he was promptly laid off. (Scuttlebutt says the small manufacturing firm couldn't afford the insurance premiums any longer, due to the gentleman medical problems)

Without a job, on unemployment, disillusioned,  and now, depressed, he stopped going to his follow-up appointments.

Soon after, he stopped seeing his friends, kept his family at a distance, and stopped taking his medications.

He went into ventricular tachycardia, which degraded to ventricular fibrillation, and died.

He was only 46.

There are probably a thousand sad stories out there, but this one hit me hard.

I thought I had a tough year.

Some people bitch and moan about how bad things are, well shut up.

It could be worse.

Coumadinization

A physician used that word in his progress notes regarding a patient on Coumadin for PE (pulmonary embolus).

I'd never seen the word, or at least seen it used in  a medical context.

So here I was ready to post some silly definition. So I googled it first, and hell, there's all these websites using the word.

So listen, if you people out there are going to be making up words to use in medical documentation, at least have the common courtesy to let me know.

Thanks.

PS:

In case you were wondering, Warfarinization is out there, too.

A Medical Excuse For Murder?

A recent murder in my area has a lot of medical professionals, well, kinda pissed.
Herbert Lawrence Peck was arrested for shooting and killing his wife after an argument. When police arrived, they found Peck hiding in a closet. The next day, he copped the "my sugar musta dropped" excuse.

I believe the defense will counter with the "liar, liar, pants on fire" gambit.

I wrote defense, meant prosecution.
Lack of caffeine will do that to you.

What Do You See?

I recently had to take my wife, Texette, to the local Urgent Care Center. We were lead to a treatment room and the door was shut.

When the Nurse came in to get a set of vital sign, she swung the door open.

The wood grain on the door made this unusual image.

I *heart* FailBlog

So, Who's The Boss?

This is what can happen when the medical community bends to family pressure:

An elderly lady has been hospitalized for nearly a month due to complications from a severe bout with pneumonia. During her stay, she developed renal failure and proteinuria.

The ever-vigilant family used Dr. Internet to ascertain that a renal biopsy might give them some answers as to why the renal failure occurred.

The Nephrologist disagreed, so the family fired him. The new Nephrologist wasn't to keen on the idea, either.

But the family was persistent, and got what they wanted.

After the procedure, the patient was doing reasonably well...for about an hour.

She had a sudden drop in blood pressure and increase in heart rate. A blood count revealed a drop in hemoglobin from 10 to 6.

Her blood pressure dropped to 60 and she was coded.

During the code, she was intubated, had rapid infusion of blood and blood products, and was placed on vasopressors.

She survived the code, but very nearly died.

I hope her family can forgive themselves.

RT Sing-a-Long: Phlegm

Logical Thinking

These are the thought processes of a male EMT who recognizes the heart attack he is having:

*Don't drive yourself to the Cardiac Center (my facility). It's 15 miles away, and I don't want people to read about the traffic accident caused by the driver with a 'medical condition'.

*Drive yourself to the nearest ER, it's only 5 miles away.

*Don't call 911 from your vehicle, even though the pain, nausea, diaphoresis and dizziness is close to overwhelming you. You don't want to leave your truck on the side of the road.

Lucky for him, and the early morning traffic, he did make it to the ER, was quickly transfered to my facility and got his 99% occluded LAD stented.

The only thing worse than 'man-thinking processes' is 'man-thinking processes' with rationalization.

Reprise: Nailed It!

As can unfortunately occur, "I's has writer's block!"
Not so much writer's block, as lack of blog-worthy material.
But fear not, stupid is as stupid does.
Until then, a blast from the past.


One of my more unusual patients was a 19 year old gentleman who came to the ED with a complaint of 'Injury at Work'.
The young man was helping his father at a construction site with nailing sheetrock. Back in the old days, when I used to help my dad, we used nails and a hammer. Nowadays, nailguns are the norm.
Apparently, this kid had finished putting up a sheet, sat down, and placed the nailgun on his lap....oops!
You guessed it, the gun went off.

The nail went through the shaft of his penis.

Being the only male nurse in the ED that day, I was asked to take his room to save him any further embarrassment. I introduced myself, asked for his back story and then examined his injury. Nothing bad, just a puncture wound through the shaft, no bleeding, and a puncture wound at the left pubis, also no bleeding.
I asked him where the nail was.

Pt: My dad took it out.
Me: Did he just pull it out?
Dad: "snickering"
Pt: No, he had to use pliers.
Dad: "laughing"
Pt: You think I'm gonna be able to use it again, you know....fuck? I'm supposed to go to California in 3 months.
Dad: 'bent over laughing'
Me: Umm. Lets just wait for the Doctor to examine you and we'll go from there.

Damage: Hairline fracture of the pubis, puncture wound of the shaft of the penis
Treatment: Antibiotics and follow up with Ortho as outpatient

Afterwards one of the younger NAs asked me what the odds were of a nail going through his penis. My reply:

His odds were substantially better than most.

It's A Family Affair

I got a transfer from a neighboring hospital to the Telemetry Unit I was working the other day.

The patient had had a heart catheterization and was found to have severe enough disease to require a bypass. (The other hospital does caths, but not interventions)

Ex-Texette works at the 'Other Hospital' in their Cath Lab.

My daughter, JoJo, is doing her clinical rotation on the same Telemetry Unit and was assigned the same patient.

One patient cared for by three members of the same family.

Very cool!

Get Off Your Ass...

I was working on one of our step-down Units recently, a Unit I don't like working because I feel that some of the staff are lazy.

Thanks for proving me right.

As I was getting ready to round on my patients, I heard the distinctive 'beeping' of an IV infusion pump from the opposite side of the Unit. I went ahead and rounded on my peeps.

As I returned to the Nurse's Station, some 15 minutes later, the alarm was still beeping. I decided to check it out, found the room, and corrected the problem (kinked tubing).

I looked at the patient assignment board to see who the nurse was.

There she is, at the Nurse's Desk....on the computer....on Facebook....tending her Farm.

Bitch!