Saving a Life

She was six, maybe seven years old. Rumor in the suite was that she had been battered by her parents. There was nobody that cared for her enough to sign a consent. Not even an attorney. She had been stored somewhere in the hospital, on life support, as nurses and doctors valiantly tried to lower her intracranial pressure.

We gingerly transferred her to the cold back surgical table, and Patty removed the ambu-bag from her ET tube to transfer her to the array of anesthesia equipment that would keep her safe. Patty had her lavender hoodie on already, the chill in the room would soon be removed by the intense surgical lights. We transferred monitors and Patty pumped her pink pedi bag a couple of times, this time not having to instruct the unresponsive child to watch the balloon go up and down.

I gazed at the child's swollen little eyes, purple and black from assault, the corneas blood crimson, the pupils unresponsive underneath the swollen slits. I felt a lump in my throat, a growing anger that parents could treat an innocent in this way. Patty placed gauze and tape over the blackened eyes, intended to protect the organs, but also concealing the shame of their horrific appearance. After adjusting a few dials, Patty settled back into the latest pulp novel.

We removed the polymerized spica cast. We would have to prep and incise her abdomen. Underneath the pretty pink shell, she was again purple from the assault, her little pelvis broken. My scrubs were visibly shaken. "Why are we even doing this?" asked Kevin aloud.

"Shhhhhh!" I replied. If she could hear us, I did not want her to hear the doubt, the ambivalence, the fear, and the growing anger among us. She deserved love, and hope, not rage. I prepped her as the scrubs filed outside to scrub in.

"Doctor Fakhouri, this is Chasity _________ for a Cisterna magnum shunt," I announced as the masked surgeon bent forward to dry his dripping hands and arms with the towel offered by the scrub. He said nothing in response. He just donned his gown like so many times before, stuffing his hands into the sterile gloves offered him, and performing a pirouette to wrap the ties around himself. I did not particularly care for Fakhouri. I took pleasure in pronouncing his name "Fukyuri."

The tone did not register at first. "V-Tach" announced Patty, moving instantly to the pink balloon. Shit. I stripped off the drapes and threw them across the table. No pulse. The child's battered chest and abdomen were still wet with betadine as I began bare handed compressions. I overheard Fukyuri tell a scrub to get the anesthesiologist and he stripped off his sterile paper gown and tossed it in the kick bucket on the way out. Kevin tossed me adult defibrillator pads as he hooked them up to the Codemaster.

"No, Pedi," I snapped as I threw them to the floor. I grabbed a piece of torn drape to wipe the wet betadine from the child's chest while I continued compressions. Patty was pushing drugs furiously. Kevin quickly passed the pedi-pads and I slapped them into place. I looked at Patty.

Patty looked at me. "100 joules." Crrrrrrrrick. BeeeeeeeeeeeeeeeeeeeeeEEEEEEEEEEEE. "Clear?"

"Clear!" Bam! The child's body lept and shuddered with the force of the shock coursing though it. We looked at the screen, hopeful..........

Asystole. No, this is the new world. The politically correct world. Pulseless electrical activity. Dr. McIntosh charged into the suite, and was buffeted with a verbal barrage compressing the last two minutes of activity into a few seconds as I continued compressions. Crrrrrriiiiiiick BeeeeeeeEEEEEEEEEEEE. "Clear?" he asked.

"Clear!" Hands up, thighs away from the table. Bam! The child lept and settled again, lifeless. I found my place on her little chest. 1, 2, 3, 4, 5, BeeeeEEEEEEEEE.

"Clear?" Hands up, step back.

"Clear!" BAM! Shudder, settle. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, ..............


Later, we reverently washed the battered little girl, transferring her gently back to her gurney.

Tears were in Patty's eyes as we piloted the child past Recovery and to the morgue. "It's better this way, I suppose," Patty said.

"No. It's not." I replied firmly.



It's not.

The Laryngospasms

For Nursing Instructors

I love to teach. About a year ago, I wrote a treatise on nursing students and how they are frequently abused in the clinical portions of their learning. It explains how I really feel. I suggest you click the link and give it a read before proceeding here......

Now, I want to explain something to all nursing and scrub tech instructors. I reserve the right to send anyone out of a surgical suite, procedure or treatment room where I may be working. Period.

Make certain your students know how to behave. Tell them to turn off their cell phones and leave them at home. Text messaging is not an option. Tell them to talk little, listen much. Tell them to be respectful of my patients. Tell them to be respectful of my physicians. Tell them to be respectful of me. Tell them that if the case starts to go to shit, they are to back up against a bare wall or get out of the room. Tell them to stay out of the way. Tell them that if I instruct them to "Please leave the room," they are to do so. Right then, without looking back. Without argument. Period.

If I send your student out of the room, you are free to ask me why. Later. I will tell you exactly why. Do not complain to my boss. He will back me. To the hilt.

If you go sniveling to my boss about me asking your students to leave the damned room, then I understand the problem. You are the problem. You have failed to teach your students basic etiquette. I'm not surprised, as you fail to demonstrate it yourself. I am not here to teach your students. I am here to successfully run cases and keep these patients alive until I transfer them to another nurse able to do the same. You are here to teach your students. And you and your students can look in through the damned window and wonder what the hell is happening from now on.

That is all.

Solutions

As I was strolling past the ICUs this morning I noticed a computer generated sign that a nurse manager had scotch taped on her door. "Enter With Solutions" it said. Some card had scrawled underneath D5 1/2 or NS?

I chuckled to myself. That's about right. In the trenches, a solution is what you hang, not what you find to take to your manager. A nurse in the trenches goes to her manager with problems. She enters with problems. She leaves with solutions. At least she does if her manager is doing their job.

While it is nice to have your staff bring you solutions to their problems for you to implement, hanging such a sign on your door is tantamount to hanging a sign reading "Take Your Problems Elsewhere." That definitely sends the wrong message to your staff.

Physicians and Guns

Should a physician have a gun in his office?

Go. Read. Comment.

My comment:

Physicians have the right to have any legally owned object in their office that they desire. They have a right to the ability to effectively protect themselves and others from violence. I am glad that is not disputed. We are not talking about a patient or family member acting out. We are not talking about verbal threats. We are talking about someone attacking another human being with the intent to cause grave bodily injury or death.

As far as your questions:

Would you not see a doctor if you knew he had a gun in his office?
The physician I see does carry a gun. I assume it is also in his office if he is there. I would not change physicians because of this. In fact, I am comforted knowing he has the ability to effectively stop a violent attempt on his life and the lives of others. He has taken the responsibility for saving lives from a violent attack.

Do you feel that physicians are similar to the Red Cross and that they should be neutral and conflict avoiding?
I believe that physicians should be proactive in quelling conflict. They should have the ability and means to stop conflict. They should not be disaffected bystanders who studiously avoid, indeed retreat from conflict. When violence occurs, there is no neutral position. Either you allow it to continue or you stop it. The real question is which path you take.

Physicians, when they enter med school, often want to make a difference. They want to save lives. The financial aspect of medicine is a bonus. The lack of effective self defense will not stop violence. When violence occurs, the firearm becomes a life saving tool, much like an AED or a fire extinguisher. Looked at from this perspective, the gun in the physician's hands is no different from any other device in giving him the means to save lives.

Surgical Screw-up

I have a feeling a time out was not done here.

ER Visit

RING RING RING RING RING RING RING

That damned hospital fire alarm.......Why does it have to be so damned loud? Isn't there an OSHA regulation or something? Those of us who hear will assist those who cannot. We don't want to join them in their deafness!

I mean, come on.......We have a morgue down there.......Dead people........I don't want them waking up and running outside!

Nursing and Other Blogrolls

I've separated out and posted another hard wired blogroll for my nursing/medical type favorites.

The nursing and medical communities in many parts of the U.S. are politically anti-gun, and vocal. I encourage all rational, thinking gunnies to visit these nursing/medical type blogs and comment. Encourage the medibloggers to come to your own blogs through thoughtful commentary.

I encourage all rational, thinking nurses and physicians to visit these gunnie type blogs and comment. Encourage the gunbloggers to come to your own blogs through thoughtful commentary.

It is only through mutual respect and understanding that we will reach the truth of the human condition and the problems in society. It is only through reaching the truth that we can solve the ailment.

CPR for Dogs

Kissimee, Florida. -- Kissimmee firefighters on Tuesday revived several dogs by performing cardiopulmonary resuscitation on the animals, which were rescued from a structure fire.

CPR can often be performed effectively on dogs. To give respirations you must keep the dogs mouth and lips closed to form a seal, and give respirations through the nose. Cover the dogs nose completely with your mouth to prevent air from leaking out. Have the animal on its side and watch for the chest rising to confirm effectiveness. To give chest compressions you need to press from the side, placing both hands palm down, between the third and sixth rib on the chest. The ratio of respirations to chest compressions are the same as for humans, 30:2. CPR for dogs is usually needed as the result of smoke inhalation or drowning. Rescue breathing usually results in a doggie life saved, especially if the canine still has a heart beat. Once the dog's heart stops beating it is less likely that CPR will be successful.

How to Give Canine CPR by Lori S. Mohr

Heimlich Maneuver for Dogs by Warren Eckstein

Recovery

It was still a bit before noon, and all my cases were packed away in PACU. My partner and I were preparing to get a bite to eat and leave for the day. As I was putting on my lab coat I noticed a slight argument conversation between a family member and a nurse. I inquired as to the nature of the disagreement and received the old "Nothing we can't handle" response. Sometimes though, the introduction of a white coat and a scrub cap can make all the difference, so I strolled over to have a look.

The lady I had worked on at 6AM was still in recovery. Her son was outside, wanting her to be released immediately to the floor. The lady was fully recovered, sitting up in bed wondering why she was still there as well. I took a look at the post-op orders. The surgeon had written orders that she could return to the floor at 12:00. She was to be recovered until that time. I went outside to speak to the son.

The son was quite agitated as I told him his mother was doing fine in recovery. He said he knew that, and that was not the problem. It seemed his father was being discharged from the sixth floor at noon to be admitted to a long term care facility. His parents had not seen each other for over a week. The gentleman's father had Alzheimer's, and was being combative.

I went back into Recovery, and informed the nurse I was taking the patient upstairs. I was told I couldn't do that, not without an order from the surgeon. I explained recovery would not stop. I told the nurse to give me a quick verbal report as I assisted the lady into a wheelchair, and retrieved her teeth and spectacles. I wrote down the last set of vitals displayed on the monitor and I disconnected it. The lady was not on oxygen anymore. Her vitals were stable. I had two nurses fussing at me as I told them I was assuming my patient's care again. I had ten minutes.

The elevator ride was silent, neither of us speaking to the other. As the elevator doors chimed open, I asked the lady which room her husband was in. Room 626. I rolled her up to the door and took a peek inside. The EMTs had an ambulance stretcher beside the bed. A nurse, a nurse aide and two EMTs were trying to convince the old geezer he would be fine if he allowed them to transfer him. He was having nothing of it. I could tell by the twisted sheets and furrowed brows that it had not been pretty a few minutes earlier in that room.

"Howard!" she demanded, "Howard, just what the Sam Hill are you doing?" A snaggletoothed grin crept across the old man's face as my patient rolled her wheelchair into the room and inserted herself between the nurse and me. "Howard, you behave. You know I wouldn't let nothin' happen to you that would be hurtful." The glow of recognition enveloped the man as he lay speechless gazing at the woman he loved. The old man said nothing, only staring contentedly at his bride as the EMTs moved him gently to the stretcher and strapped him down.

"Howard, now you be good. I'll be by to see you as soon as I can," his wife told him. I rolled her backwards into the hallway to allow the EMTs to finish up. While we waited, I strapped a Dinamap to her arm and recorded the vital signs on a scrap of paper. As the old gent was rolled out of the room, his bride leaned forward to kiss him on the forehead, telling him it will be OK, she will be there soon. Then they parted yet again.

The lady's son shook my hand, telling me he had to go with his father to make certain he settled in comfortably. We bade him goodbye. It was another quiet elevator ride back down to PACU. Once there, I again hooked the little lady up to the monitors, and recorded her vital signs and notated them on her chart. The recovery nurse fawned over our patient a bit, giving me a distinctly icy shoulder as I gave report back to her. I finished, and started to leave, but the little lady grasped my hand quickly. She couldn't quite say it, but she silently mouthed thank you. A single tear rolled down her cheek.

This morning I awoke to my pager's beep.

I'm not on call.

Heh......ZZZZZZZZZzzzzzzzzzzzzzzzz

Public Service Message

Hat tip Phlegm Fatale

Physician Education

When was the last time you were asked by your physician if you had guns in your home? It is no secret that many medical and nursing professional organizations espouse anti-gun and anti-self defense agendas. Guidelines issued by the American Academy of Pediatrics even encourage doctors to ask your children about guns in their homes.

Today, I learned about Doctors For Sensible Gun Laws. This organization, founded by Dr. William B. Rogers is taking on the professional groups who have sided with the anti-gun lobby. A quote from a letter to the American Psychiatric Association:

"To treat firearms violence as a medical issue in an effort to push for further gun control is absolutely ludicrous, when all the relevant research in the field of criminology reveals a net benefit to society of gun ownership."

Further:

"As physicians, we must be advocates for our patients. Embarrassingly often, we have advocated "treatments" without full knowledge of the facts (therapeutic bloodletting comes to mind). And while lack of research and scientific knowledge might be a partial excuse, that certainly isn't the case with gun-control, where solid research has been done, but organizations like the APA ignore this research because it doesn't fit their preconceived ideas."

The doctors affiliated with Doctors For Sensible Gun Laws also discuss what a patient can do when a nurse or physician pushes his or her own political agenda regarding firearms. Known as boundary violations, these inappropriate questions and inaccurate declarations are highly unprofessional and take advantage of the therapeutic relationship that should exist between nurses, physicians and patients. For many gun owners, the ignorant accusatory condemnations that make up this type of interview destroys trust and fills the relationship with justifiable suspicion and even hostility.

Nurses and physicians need to get out of the gun control business. By allowing gun control advocates to be lead them around by the nose, they lose credibility among the patients they serve. I am blessed to be living in a free state, one that cherishes the second amendment, regardless of what happened in Louisiana's own San Francisco known locally as Nawlins. I know and shoot with many physicians and nurses. The professional organizations that seek to strip us of our rights do not represent them, or myself. Many of us refuse to join, much less pay dues to such a group. That though, will not bring about change. More than enough gun ignorant nurses and physicians are available to keep the funds coming to support those at the top of the bureaucracy of health care.

What will make a difference is educating doctors and nurses and hospital administrators. One by one. It seems a daunting task, but each time a gun owner submits to these types of interviews without effective protest, ground is lost. Print a copy of this form. Hand it to your doctor or nurse when they try to intrude upon your privacy and your constitutional rights. Doctors For Sensible Gun Laws also has a polite letter and an angry letter prepared as templates to mail your physician if such a boundary violation has already occurred. Do not simply avoid your physician or find another physician, educate the one you have. Until we educate health care providers in large numbers, political winds will continue to influence them, and as a result the care we all receive.

First, do no harm. What a concept. Doctors need to stick with it.

Patients Patience

Where's Xavier?

I've been on call since Tuesday, the 20th. I've been called out every night, every day. I've had at most four hous of sleep each 24 hour period. You would think the highways would run out of drunks. Be safe out there. I go off call on Monday 11/26/07 at 1500. If you bust yourself up on the interstate until then, come see me. I'm the Zimmer repair man......
I'm getting some sleep.

Diagnosis Wenckebach

Emergency Surgery

This home video may not be suitable for the queasy.

Daylight Savings Time

4:10AM. My wife says it is Daylight Savings Time. I get to sleep an extra hour. Or do I?

Except I am on call and first case starts at 7:00. That means I have to be there an hour prior to set up. I'm not certain what the team is doing this weekend, since nobody discussed it. They may come in an hour late. They may come in at the former time, which would be now 5:00AM.

My wife doesn't understand team dynamics. She tells me to go back to bed and get another hour of sleep. I can't. I'm going to the hospital. As the leader of the team, it is far better that I be the dumbass that was an hour early than the smartass that was an hour late. It's shaping up to be an interesting day.

Manson and Other Charlatans

Over the past 12 hours, to bide my time while on call, I have been watching interviews of Charles Manson. I observe to learn, to analyze, to prepare myself for when I must deal with mental pathology........Again. Manson was interviewed in 1981 by Tom Snyder, and again in 1987 by Geraldo Rivera. That is one spooky sociopath.

Watching Charles Manson gives one a sick feeling of revulsion. He attempts to manipulate an interviewer into feeling empathy, appearing to allow them to enter his world, knowing by their presence that they want to see inside his mind, and then he suddenly slams the door when they try to peep inside. For Manson, these mind games seem to be a method of control, a not so discreet game to boost his own feelings of insecurity and inadequacy. He is a looser, and he knows it. Still, because of the interviewer's very presence, he has gained something.

I was struck by how common Manson's pathology is. He is a garden variety sociopath, albeit a very hardened, incorrigible one. I have seen his thought processes before....They are not unique. The denial, the manipulation, the evasion, the refusal to directly answer questions, the deflected responsibility, the word salads and the mumbo jumbo bullshit that so many professionals call a disease. It all allows the sociopath an excuse for bad and criminal behavior. If there is any truth to anything that Charles Manson claims, then it is that the whirly-gig performance of the incarcerated criminally insane prisoner and psychiatrist keeps them both fed. To me, it all appears to be a cantankerous waltz with madness, a grinning monkey pumping a squeezebox and tapping his foot to the side.

As nurses, we must interview patients. I suppose this is why I do not handle psychiatric patients well. I would probably handle them fine as a corrections officer, but I usually fail as a nurse. I see right through their bullshit, and I do not accept any of it. I hold them responsible for their actions and inactions. I have absolutely no empathy, and they know it. I believe the best thing that could happen to them is productive work digging potatoes in the fields of a farm labor supported mental hospital. Let them be a message to society.......If you don't want to be placed there, then act right. If you can't figure out how to act right, then here's a shovel asshole!

My wife is a psych nurse, and God knows I love and respect her for it, but I have no idea how she can put up with the loads of crap that comes out of some of these people's minds. They don't want to "get better". The psychosis is a defense mechanism, an adaptation for survival. I do not pity them. I used to have to tolerate them occasionally. Thank God I now only have to say "Breathe deep," do my job and roll them out and into the care of another nurse before they wake up.

And some kids think Manson's a hero. Idiots.