No Dilaudid for You!

A patient that is well known to us arrives by ambulance. We all know what he wants....the prized fix of dilaudid. He only comes in for that and amazingly seems to get it.

The doctor on shift today is one that everyone likes and respects. I think it soared to new levels after his assessment and subsequent handling of our frequent flyer.

The doctor told the patient he would do everything in his power to help him with his pain except he was not going to give him dilaudid. The patient told him, no thanks! He will sign the AMA as soon as the nurse could bring it because he said he can go down the road to another hospital that would give him the drug he wants.

Our patient who was incapacitated with so much pain, jumped off the stretcher and walked away without so much as a hitch in his step. 

Bravo Doctor! Bravo!

They Don't Like It.

I've worked the past several days at both ER's I do PRN work. The hot topic of discussion was the ACA aka "Obamacare" which was brought up by the patients. I never bring up controversial topics with patients. 1) It's not professional 2) I don't have time to get involved with deep discussions unless it's with regard to the patient's health 3) I don't want the appearance of biased based care.

With that being said, the patients I spoke with hate the ACA. They're angry, they are afraid, especially the elderly. On one shift, I was the float nurse. It's a position where you are not assigned any rooms or patients and you float around and help people with doctor's orders or catch up on patient care. We affectionately call that position "the turd". Get it? ha. ER humor.

I was helping this one nurse with a new arrival. The couple was originally from a European country and came to the US years ago. They were awesome, friendly, and had a sense of humor. I wanted to shrink them and place them in my pocket for the day. As I performed my assessment and started the IV, they told me about their original country and why they came to the US. It was fascinating. The wife expressed her absolute fear and where this country is heading and the direction of the ACA. "You must stop this. You don't want this. We left a country with this type of healthcare and it is horrible. Many people, the old people, will die just because they are old. They don't consider if you're healthy and old - they see the age and won't spend any money to help you because of it." They also both expressed their fear of the dwindling privacy in this country and compared it to the rise of the Gestapo and Hitler since they were there during that time and remembered it. "You have to understand what this all means to this country. I don't think the Americans truly understand because they haven't experienced something like this before. We will all lose our freedoms."

I don't know if they thought I personally had a way to fix this, but their passionate hushed tones and pleading made me feel like I did.

The other patients did not have the same story as this couple, but were all against the law for various reasons: lack of privacy, more money to pay, fear of losing freedoms and not having control over their health. I even had a few conversations with different doctors I know all in various specialties. It was unanimous, doctor's didn't like it either.

I'm not saying that my little world represents the entire country, but I'm sure there are more areas like mine.

Thanks to Barbie, I'm an Orthopedic Surgeon!!

My daughter was talking about school and how they were discussing professions. She said everyone told the class what one of their parents did for a living. So I asked her if she spoke about me or her father.

"I told them what you did Mommy and how you are an orthopedic surgeon."
"WHAT??!!"
"Aren't you an orthopedic surgeon?"
"What did your teacher say?"
"She said, 'Wow, I did not know that.'"
"Our neighbor is an orthopedic surgeon, I am not one. Where did you get this from?"
"I thought you were one."
I'm utterly confused at this point. "Uh...no. Where do I work?"
"The ER."
"What do I do there?"
"Umm, you're a doctor?"
"What? No, I'm a nurse, honey. I didn't go to medical school. You should know that."
"But don't you cut people open in the ER?"
"I try very hard not to." (lol)
"But you fixed Lisa's (a friend of my daughter) Barbie leg that time. Remember?"
"Yes, but fixing a doll's leg doesn't make me an orthopedic surgeon. I'm an ER nurse."

If I had known that popping Barbie's legs back into their sockets made me a surgeon, I would have been billing patients a long time ago.

Making Simple Things Difficult....

I've been frustrated with my daughter's school lately. Actually, it's been a growing frustration. I remember (decades ago) carrying multiple books home with me in elementary school to do my homework. These kids have copied work sheets - no books to bring home. I've requested to see her books in the past just so I knew what the heck they were learning. How are parents suppose to monitor and help their children with homework if we have no idea of what they are suppose to be learning?

I also thought math is math - you can't change the basics, however, apparently you can. She showed me her worksheet and it was basic multiplication:  135 x 23 for example. I told her, "You know how to do this, is this just a review?"
Nope. They have to solve the problem using the distributive property of multiplication. Now are they just trying to confuse the hell out of these kids or are they preparing them for algebra? Shouldn't they just practice the normal way of solving this problem to master the basics? She's in the 5th grade - I don't foresee algebra until high school.
So, using that example from above this is what you have to do for the problem:

135  -->     100+30+5
x23  -->      20+3
-----------------------
100 x 3 =     300
30  x 3 =      90
5 x 3 =         15
100 x 20 =   2000
20 x 30 =     600
20 x 5 =       100
_________+_______
                   3105

I asked my daughter if she remembered how to do this problem 'normally' and she did. I guess I'll have to contact the math teacher and find out what this is all about. I bet these teachers think I'm a pain in the ass because I usually ask for materials and writing notes because I want to know what's going on with their classes when I see something strange to me.

So she comes home this past Friday with a failing grade on a science test. I'm surprised because she loves science and is normally a very good student. She's learning basic chemistry and she was able to bring the book home. We reread every chapter this past weekend together, reviewed her old test and I had her take the make up exam on her own. She had one question that she didn't understand. I read it and couldn't answer it, I showed it to my husband and he couldn't either. He said, "This is a bullshit question." We both have multiple degrees, certifications, and he has a graduate degree - together we couldn't answer this question - how is a 5th grader suppose to do it?
So I wrote yet another note to the teacher requesting that she allow my daughter to bring home the book once a week so I can review it with her.

So now I have math & science to do with my daughter, keep an eye on my son's schoolwork, and prepare for my next degree starting in January. If we could add another few hours in the day, I might be able to do this all. Sigh.

Where Vomit Hides....

My 7 year old son was setting up the ole 'I'm sick, so I don't know if I can go to school tomorrow' routine. He complained of a headache, I gave him some ibuprofen then he complained of nausea.
After describing what his day would look like in no uncertain terms (in bed, no Wii, no TV, no friends, no fun), he mysteriously got better after taking his shower.

"Mommy, I feel better. I think the medicine helped. The throw up went into my feet."

"What?! Your feet? You mean your nausea is gone?"

"No, the throw up. The medicine scared it to my feet."

"Umm, okay. Why did it go to your feet?"

"Because that's where throw up hides for me, in my feet. Everyone is different. Mine goes to a secret, dark hiding spot in the middle of my feet and when I have to throw up next time, it rushes out, up to my mouth and I throw it up. I'm fine now, it's locked up."

"I did not know about this."

"You're a nurse, mommy, didn't they teach that to you in school?"

"I guess not."

"Where does your throw up hide?"

"I don't really know."

"You should look at your feet, I bet it's in there."

LOL!

Hope without 'this'

I had another young patient in the ER for drug related problems. As the doctor was bedside and I was assisting him in a procedure, the patient mentioned that she was starting nursing school. The doctor engaged in some more chit chat and then left the room. I decided we were going to have a little talk while I bandaged her wound.

"We're going to have a chat."
"I know, I know....I did a stupid thing. I swear this is the last time I will do something this stupid. I've only done this once before."
"Yeah, well....you say you're starting nursing school, if that is a goal of yours, you're not going to reach it by doing this. You can't be a nurse and do drugs. No one will trust you or hire you."
"I know."
"Look, I'm old enough to be your mother, so I'm going to give you a little motherly advice."
"You don't look old enough to be my mother."
"Well, I am."
"My mom is a drunken bitch, she's horrible."
"I'm sorry about that.....do you want to do the same thing to your child? Do you want your baby to have the same childhood that you did?"
"No."
"You're young, pretty, and you must be intelligent to get into that nursing program - you have a great opportunity to have a terrific life.....do you want to trade all of that and your children for this?" I held up a vial to make my point. She looked at me with tears in her eyes.
"This will take away everything you have in life and this will be the only thing you will have left. Is it worth it to you? Don't answer me, just please think about it. Get help if you need to. Don't go down this path. Don't do this to yourself and your family. Don't trade this for your baby. You can have such a wonderful life, you can be a great mom to your child, you can have a loving family life even though you didn't when you were young, you can have a satisfying career.........don't throw it all away, don't let this take it all from you because it will. Think about it, okay?"
She shook her head.

After I did her discharge teaching, I turned to her and told her she could get dressed and go home.
"Think about what we talked about, okay?"
"I will."
"I don't ever want to see you back in my ER for this again. I mean it."
"You won't."

As she was leaving she passed me in the hall, gave me a tight hug and whispered, "Thanks for being my mom."
And then she left.

I try to talk to every drug user that I have as a patient. I realize it's mostly wasted breath on my part, but if I can reach just one person, just one.....then it's worth it.
I have hope for this one.

Stop taking meth and feel better!

"Okay, I'm going to discharge you now and take out your saline lock."
"Wait, why am I all jittery?"
"Well, because you've been taking meth for 2 days."
"Wait, what are all of these things all over my arm?"
"I just took your blankets off of you. Those are goosebumps from being cold."
"Wait, why do I feel so bad?"
"Because you've been taking meth. Don't do that anymore."
"I want to speak to the doctor. I don't like you or your answers!"

"Doctor, why am I jittery?"
"You went on a meth binge. Don't take meth if you don't want to feel this way."
"What are these things all over my arms?"
Looks at her arm, "goosebumps."
"Wait, doctor, I feel bad, why do I feel so bad?"
"You took meth for 2 days. Stop taking meth and you'll feel better."

She didn't like the doctor's answers either.