Playing Lead Guitar

"What are you doing now-a-days, Xavier?" one of my old nursing instructors, now gray but still intimidating, asked me. I was dressed in my finest duds for the pinning of a new crop of students nurses, all fresh and eager in their starched whites, capes and caps. We were at the reception, the new nurses having recited the Nightingale Pledge by candlelight. Back home, blood soaked scrubs lay in a laundry basket in my bedroom.

"Oh, I'm the lead guitarist in a Southern rock band," I lied.

"I bet you are," she replied, peering over her reading glasses at my soul.

"If I leave here tomorrow
Would you still remember me?
For I must be travelling on, now,
'cause there's too many places I've got to see."

Esophageal varices are blood filled devils at the base of the esophagus, that arise from the azygos vein, and the superior vena cava. Usually the result of portal hypertension from liver damage, whether caused by alcoholism or hepatitis, they can become the cause of a dramatic blood spewing demise in a matter of minutes.

When the first strains of "Free Bird" begin to sound from my iPod, a metamorphosis takes place with my team. Some suddenly realize they missed their smoke break. Others realize that they are being summoned, and they enter my suite with trepidation in their hearts, but willing.

"But, if I stayed here with you, girl,
Things just couldn't be the same.
'cause I'm as free as a bird now,
And this bird you can not change.
Lord knows, I can't change."

When Big Joe rolled the gurney containing the young black man in, there were already splatters of crimson on his sneakers and blood on his pillow. I went through my recital of preparations with the chirping at the beginning of "Free Bird" filling the air. "Do you drink? Smoke? Illegal drugs?" Negative. "Hepatitis, HIV, AIDS, Tuberculosis, Sickle Cell?" No.

Realizing that Lynyrd Skynyrd may be the last thing this young man wanted to hear, I switched the playlist to Motown.

"You can't hurry love
No, you just have to wait
She said love don't come easy
It's a game of give and take......."

"False teeth, false eyes, hearing aid, hairpiece?" I asked as though reciting a poem long memorized. The young man removed a partial plate with several gold teeth. "Tounge ring or lip ring?" No. I looked over his history, searching for an idiology. He had been banded on five previous occasions. That was not good. Each previous banding had likely resulted in scar tissue right where we needed to work. I got my goggles out of the drawer and tightened the cinch securing them to my head.

The team assembled, consent obtained, we began the sedation. He did not fight much as we entered his esophagus with the gastroscope. For a man of his age, that was not a good sign. The base of his esophagus was a fearsome mass of lavender scar tissue and one violent purple bulging clot. "Bander," I ordered.

A band ligator was being loaded on an alternate scope. It is a device that can deploy seven rubber bands, one at a time. Seven chances, seven little rubber life preservers to stop a varicele bleed. Just yesterday, we had saved a life by working with two scopes, the first applying direct pressure against a hemorrhaging varicele while the equipment was loaded on another. "Hurry."

"Ligator." As the first scope was ripped from the young man's esophagus, a great rush of bubbling blood spewed from his mouth and nostrils. I quickly inserted the Yankauer to the back of his oropharynx to keep us from being sprayed in a volcanic gush of hematemesis. The banding scope went down into the torrent of blood, the monitor screen an unfocused blur of red. My physician was relying on memory, working blind. I continued to manage the flow of frothy crimson as best I could when at last the cup to the bander reached it's mark and sucked the tissue inside.

"Although I might be laughing loud and hearty
Deep inside I'm blue
So take a good look at my face
You'll see my smile looks out of place
If you look closer, it's easy to trace
The tracks of my tears."

Through the ligation cup, we were looking directly into the azygos vein, at it's opposite wall. Pop! The first band was deployed. Suction released. The tide of blood blew the precarious band off the scar tissue, washing it right up and out of the young man's mouth. Quickly the physician reapplied pressure to the area with the gastroscope itself.

"Get me blood!" I ordered.

Pop!

"They are still type and matching."

"Emergency O positive!" I ordered again as I looked towards the monitors.

Pop!

"Outside I'm masquerading
Inside my hope is fading"

37/12...... SpO2-0. Damn. "He's not moving air Doc," I called for the crash cart. Big Joe rolled it in. Laryngoscope. ET tube. Bag. No carotid pulse. "Start CPR." Big Joe found his mark and as I bagged, he brought up the pressure with his compressions. "Have we got that blood yet?!!"

"Morrhuate Sodium," Doc ordered. "Epi!" More blood gushed from the young man's mouth and nostrils, dribbling across his dead eyes. "Epi."

Emergency O positive blood was spiked and shoved in. A femoral line was inserted and secured.

"Stop compressions." No pulse. "Resume CPR." I switched positions with Joe and he bagged as I compressed the chest. When the respiratory therapist arrived, she relieved Joe and he left the room. With each compression, more blood was being blown from the patient's mouth. The respiratory therapist cupped her hand over the patient's mouth to keep the cataclysmic flow off of us.

"Bicarb."

"Dopamine."

Another unit of blood. Bagging and compressions. Nothing. Finally, CPR was stopped. He was dead. Bled out. My paper scrub cap was stuck to my forehead with sweat and blood. I found Joe crouched outside the door. He had grown up with the young man. They were team mates on their high school football team. Friends. "I'm sorry," I said. Joe just nodded. Dried tears streaked his face.

"Bye, bye, its been a sweet love.
Though this feeling I can't change.
But please don't take it badly,
'Cause Lord knows I'm to blame."

I'm Sorry.........

I like this so much, I had to post it again.........



The Laryngospasms will be performing at the "Sputum Bowl," put on by the American Association of Respiratory Care (AARC) in San Antonio, Texas on December 7, 2009.

A Light Rain

Beep beep beep beep beep beep. Internal bleed. ER1. The night is quiet as I return to the hospital. My dinner sits on the stove at home. I walk through the ER to assess the patient. Inside the ER, a lone nurse is working in the first trauma room. A man lies on the gurney with a unit of blood infusing on a pump. He is unresponsive and clammy. His BP on the monitor, 36/17. "What's his hemoglobin?"

"5.2"

"Get some trauma tubing, a pressure bag and four more units. Now." Ding ding ding ding ding. Damn. No pulse. I start chest compressions. "Get the doc in here!"

The other half of my call team walks in. "Bust open the crash cart. Get atropine" My partner, although not a nurse, responds well. He assumes compressions, I push the atropine and grab an ambu-bag. While I check for a pulse, he slaps pads on the patient's chest. Chest compressions. Bicarb. The rest is a blur. Bicarb. Art line. Dopamine. Levophed. Femoral line. Pulse. 94/44. Hang the blood. Pressure bag. More blood. Ding ding ding ding ding ding ding Damn. Chest compressions. Tube him. Vent. 150 joules "Clear!" Bam! Epi. Chest compressions. Sweat on our backs, blood on the floor.

It's strange what you remember during a code. A nurse not knowing how to put blood in a pressure bag. Someone saying "He's not going to make it" and another responding "She's got a sickle in her back pocket." We coded the patient three times. Later, two and a half hours later as I leave, a family sobs in the parking lot. I walk past another ambulance with the rear doors yawning open, an elderly man with an oxygen mask on a gurney inside. It is raining a light rain. I have pork chops on the stove at home.

The Two Hoser ER Stethoscope

I understand ER is airing it's last episode tonight. I remember watching it for the first time, as a nurse in my first year of practice. I was a burgeoning cardiac nurse back then. At work a curious phenomena was occurring. Nurses were buying cheap two hose stethoscopes and slinging them like a five pound yoke around their neck. The two hose stethoscope felt like a C-clamp in your ears. You couldn't even hear an S3 through them. I could not understand why any nurse would want to spend a twelve hour shift with such a piece of junk around their neck. I was the only nurse sporting a Littman Cardiology II that year.

Finally, tiring of my wife gushing over a new edge of your seat TV drama, I agreed to watch it one evening. I saw Anthony Edwards, George Clooney and Eriq La Salle spit out medical gobblety gook STAT with a swinging boom camera moving from character to character like a drunken bee in a poppy field. Lusty nurses, hunky doctors, drama on the half shell. All of them wore five pound two hose stethoscopes purchased by a wardrobe manager on a budget.

I took one look at my wife. She was transfixed. The illumination of flashing images of her future in the dramatic world of nursing were beckoning her like a flickering neon Budweiser sign pulls patrons into a seedy pub from the rainy streets. "BP 56 over 20! Atropine! STAT! He's not responding! Chest Compressions! Hey! Who took my donuts?!!!" That was enough for me. It was just another form of General Hospital with a dose of blood, gore, screams, groans served up with melodramatic license. My wife loved it. She was in nursing school and had a two hose stethoscope too.

Like me, all the physicians I knew carried Littmans. Only the fictitious physicians of TV land could afford the $29.95 two hoser double tubed five pound chrome plated cool kids gear that the nurses at work carried. By contrast, the nurses on ER wore budget priced single hose stethoscopes with the heads removed to slip a roll of medical tape on the thing. I suppose they wouldn't want a pocketed roll of tape to ruin their figure.

Carter is giving a speech about the Joshua Carter center now, and my wife is still transfixed, misty eyed. The doctors in the bright box of fictitious medicine are now wearing Littmans as a piano plays chords to tug the heartstrings. There is not a two hoser stethoscope to be seen. "Whoop whoop errrrrrrrrrrr whoop!" Another ambulance pulls up to the wet and windy ramp. "Twenty-two year old female! Blunt trauma to the head!"

It's been a long day. The streets outside are wet...... and windy. I seek a muse illuminated by my computer screen, with a very real pager clipped to the collar of my T shirt, hoping it stays silent. There are no plaintive piano chords if it goes off.

Twelve Days

It's been a helluva eleven day stretch, one more to go. I try not to snivel and snort about the demands of work on my blog. Who wants to read that stuff? This is supposed to be a gun blog. Tonight though, I just might.

February 23 to February 27 was busy, more so than it should have been. I stayed late every day, by an average of two hours each. I took call every other day. I went on call the afternoon of the 27th. My pager went off within two hours. I worked full days Saturday and Sunday, and on March 2, I was back to work at 6:00 AM. Each day this week, I left work late. Three days were education days for two nurses needing Arrhythmia Class as a prerequisite for ACLS. One nurse resigned. Then called in sick. Strange how that happens..... So I have been working understaffed by about 50%, with about a 40% increase in overall caseload, and no time off myself. I continued to take call every other day.

I eat, drive to work, drive home, sleep, eat, repeat. I have been able to fit in thirty minute visits to the range by pre-packing my gear, and going as soon as I get off work. Twice I was paged back to work from the range. The fact that I have been able to continue to blog each day is because I can pre-publish pieces. I apologize for the lack of coherence at times. I was just too tired to think straight.

There is much of my regular material that I haven't blogged on, simply because I have been so tired. Cassie is presently at the vet staying overnight after being spayed. That would have made a good piece. Ilsa spent her first day alone at home, lose inside the house. I didn't know what to expect that day. Would the sofas still have stuffing? Would the carpet still be in place? True to form though, my big black beauty slept on the living room sofa, watching the front door for my return. She was a good dog. That would have been an excellent piece as well. I came home one day during the last eleven to find that I now have cable TV piped into my home. I watched it for about five minutes before falling asleep. Ilsa enjoys Animal Planet. I have seen several interesting pawn shop guns, but had no time to write about them. A friend's mother was injured by a negligent discharge. Again, no time to write. I may write a bit about that one later.

It's been a tough eleven days. Then I read about a case such as this one. I have one more to go. I'm looking forward to Friday night, Saturday and Sunday.

Stay or Go?

Men in Nursing

I was reading some comments over at Fark.com about men in nursing. It seems as though I was linked to over there. Here's a smattering:

"RNs with specialty degrees make very good money. Double bonus is the number of hot chicks that also take nursing courses and career paths. Engineers make good money, but their schools and career paths are just way too male dominated."

Putting up with the stupid coont drama sucks, and no, nurses are NOT all hot and sexy. I can think of only one I've met who I would consder. The rest are fat farking slobs or skanks.

I'm a male nurse, So I know I'll get a kick out of these replies.

"what's wrong, Mister Nurse?
tired of being chastized
for teh ghey career"

"My Mom was a RN for over 50 years, and when asked if she would do it all over again, she says yes. She's in her 80's and still works a couple of days a week at the local hospital. I don't recall her making that much money, though. She is all pissed off because she can't go to Pittsburgh on Monday for some training conference because none of us kids have the time to drive her. She is threatening to drive herself. God help us all! Must hide car keys.

Mom knew a guy years ago who was a male nurse. He had a very hard time getting a job as a RN, he usually got offered jobs as an orderly, in spite of having a graduate degree. People thought it was weird for a guy to be a nurse back in the olden days. I can just imagine what people thought: homo, child molester, rapist etc. I think he finally moved out the the west coast and did much better in his field. Funny how things change. I can remember when female doctors were rare."

Me = newly single guy nurse

I get asked "What made you decide to become a male nurse?"

My reply is always "Once I considered the alternative I was more than happy to keep my penis."

What kind of a dickhead makes fun of a dude who's a nurse?

Especially since most of them were medics or corpsmen in the military. Combat medics have balls of cast iron.

"91B30 here! And I lost my original balls to an Iraqi mortar. Had 'em replaced with titanium alloy implants. Lighter and stronger than steel, more corrosion resistant than iron."

"I make fun of nurses just like I make fun of any other person whose job can be replaced by a robot loaded with a medical database. Get a real education."

"Male nurses: Too stupid to be doctors, too LOL to be real men."

"Please don't call them "your" patients. Doctors have their own patients, nurses don't. Nurses are just undereducated little helpers to real medical workers."

"As someone that has been in and out of the hospital for the last three weeks I would have to tend to agree. All doctors think that they are the smartest person and doctor in the damned world.

I went in with horrible acid reflux and abdominal pain by ambulance. The smart doctors decided that I needed four days of starving leading up to heart tests instead of a gastroenterologist. THey found nothing. Finally my RN spoke up to the doctors, and I got a GI consult. There was erosion in my esophagus amd stomach. Ta da, a genius diagnosis."

"as a doc i appreciate a good nurse. i very rarely have found a male nurse who was not absolutely excellent at thier job, maybe it's over compensation. with a code going, a drunk in dts, etc give me a good male nurse anyday. btw no disrespect to female nurses. a good nurse is a good nurse."

"Friend of mine is a Major who's been a nurse in the US Army for 20 years. He loves it. Spends all day in the cool clean hospital putting ace bandages on recruits and surrounded by young women, while other soldiers are runnning their butts off out in the heat getting screamed at.

If you look at him funny when he says "I'm a nurse" you are not going to like your hospital stay. And he'll be the one who put you there in the first place."

"Former Navy Corpsman and NYC Paramedic, Corrections Nurse and now ER RN (both in Bronx) checking in.

1) not that hard, guys. One day you might have kids, the getting past "icky" vomit, feces, urine and-god-knows-what not a bad skill to pick up. Although I get funny looks from nurses in my daughter's pediatrician's office when I request gloves to collect a urine sample from her).

2) Much less with teh ghey than I thought (more when I was in the Navy, believe it or not). Biggest professional job hazard: Old school nurses that feel threatened by a male in workplace.

3) There's drama and gossip if that's your thing (and I got a buddy who hunts to get away from his wife and kids occasionally who loves surfing the social milieu) or you can ignore it- and that's where the women come for a break from all the yenta-ing.

Otherwise, it's just a job, man- you have the opportunity to make some real differences in folk's lives, but holy crap, it ain't the mystical angel quiet servant of the doctor's word."

"Nurses are like the NCOs of the medical profession. Absolutely necessary and nothing to laugh about, male or female."

"they need someone to lick doctors assses and do 90% of the work and make 10 or 15% of the profit while the hospital administrators laugh all the way to the bank as they pay their lobbyist(american medical association) to bribe congressmen to get what they want. ain't freedom great??"

"want to work 60 to 80 hours/week? be a nurse."

"I work at a large Catholic hospital. There is definitely a "hierarchy" of nurses, depending on the nurses' education and motivation. The brightest and the best nurses usually have a specialized degree and are surgical, obstetric, or research nurses. The floor or ward nurses (the ones that tend to patients in hospital beds) are generally (though not always) the bottom of the barrel. These are the fat, cigarette-smoking drama queens that you all have been referencing. They are generally have a lower class and/or rural upbringing and pursued nursing because it was their best (or sometimes only) opportunity to get a decent job with minimal schooling (Associate's Degree).

However, it seems that male floor/ward nurses are exemplary. They are extremely kind, caring and competent. It takes balls to ignore the stereotypes and snide comments from friends, family members and strangers. Basically, men become nurses because it is what they are passionate about and they don't give a darn what others think...not because they need a way out of the trailer park."

" think everyone does it - you know, use various litmus tests to make sure the people they're around aren't complete idiots. If someone's a bigot, they're in the garbage heap. If someone's overly critical for the sake of being so, they're gone.

Making fun of someone's vocation because it doesn't fit stereotypes - yeah, that marks you as a moron of the first order. There's no need for reply, because I'm already done listening to you. Forever.

I don't think I'm the only one that has this particular filter."

"Both my folks graduated from nursing school. Mom kept going back to school, Dad stayed a nurse.
One day, someone asked my father when he graduated nursing school.
"1976," he said.
"Weren't all the male nurses still gay then?"
In all seriousness, though, there are a lot of steelworkers and coal miners who lost their jobs and got retrained as nurses.
Tell THEM they're not manly."

These examples, dear reader, are why I often say that male nurses suffer the last acceptable sexism on the job. It comes from all sides, simply because they are male, and is legitimized through acceptance. It's a wonder that nursing has the men in the profession that it does.

Being On Call

I am on call again, and I will remain on call for two hospitals until Monday. Many people who are not nurses or physicians don't really understand what the unrelenting stress of being on call means.

For me, it means remaining in my scrubs for the duration. If I take a shower, it's with my pager and cell phone outside the curtain. I don't go out to eat where I might have to wait for ten minutes to get food. I don't go shopping where I might have to wait in a ten minute line at the register. Any social engagement where getting up and leaving gracefully presents a problem is out of the question. No activities where exiting a grid locked parking lot might be a problem. No church. No funerals. No theater. No school functions for my child. I don't even watch movies on DVD. No wine or spirits. None.

I try to catch up on my sleep when I can, and I keep something to eat pre-prepared and ready on the kitchen counter. Preferably something pre-prepared that I can eat while driving through the night to the hospital. Something like a burrito or a chicken wrap. I keep my car's gas tank full of fuel.

I have to stay within a thirty minute radius of the hospital at all times. When my pager beeps, the clock starts ticking. I have thirty minutes until I should be starting the case. It is not very different than when I was in the Navy, being called to General Quarters again and and again. As I drive towards the hospital, my cell phone hums. I am getting as much information on the patient as possible from the ER staff. I am fielding calls from the doctors and my team, everyone wanting to know what is going on and what needs to be done. I do this because some person desperately needs us.

Call is supposed to be for life threatening emergencies. The truth is, it is frequently abused so physicians can meet (or avoid) the demands of their spouse's social agenda. It is not uncommon for me to be roused out of a deep sleep only to rush to the hospital and start a case that could easily have been done the next morning. I have learned to expect to be called out at any time, with no regards to when I was last called out. There have been times that I have turned into my driveway at 2:00 AM only to have my pager go off again. Keep in mind that while this is going on, I still have scheduled cases that start at 6:30-7:00 AM. Sometimes I just stay at the hospital and sleep on a gurney in a dark room.

I usually do not take five days of call in a row. Doing so brings a person to the brink of total exhaustion and irrationality. The most I usually take in a row is three days, a Friday, Saturday and Sunday. I am doing five this time because other people took call so I could spend Christmas and Thanksgiving with my family. Unfortunately, my scheduled call weekend fell right after New Year's Day, so I get five days in a row.

My pager just went off............

Reverting Back to Training

It had been a long day at the hospital, and rather than go straight home, I changed scrubs and found a comfortable stretcher to take a combat nap on. I was still pretty wiped out when a nurse turned the light on to commandeer my stretcher. I decided to drive home.

As I approached an elevated section on the divided highway, I noticed flashing blue and red lights on the opposite elevation. I pulled over and opened the hatch on the rear of my Cherokee. Still in it's spot was my black leather nursing bag. I grabbed it, pulled on some gloves, and went to see if I could help.

I passed several officers who surrounded a cursing and barefooted man, handcuffed prone at four points to a backboard on the ground. His feet were bloodied by broken glass. They were ignoring his profanity. I sprinted past a bloodied matronly woman in hysterics with an officer holding her away from the scene. Two conjoined vehicles were surrounded by firefighters, paramedics and policemen. The jaws of life was humming among the shouts. A paramedic saw me running forward in my green surgical scrubs carrying my nursing bag. He tapped the responder beside him on the shoulder. She looked around, and they all began to part like the Red Sea. This is not good, I thought.

"She's pregnant Doc," they said as I entered the fray.

"I'm not a doctor, but I'll try," I replied.

"Her water broke," I heard someone say.

Inside the crushed sedan was a woman with her knees pinned to the dashboard. She was in labor. Her mother had been transporting her to the local hospital where I worked. She was in labor.

Apparently, the handcuffed man had stolen a pick-up truck from a automobile dealership. In trying to evade the law, he had driven the wrong way onto the overpass. At the crest, he had smashed into the sedan at high speed. The smell of gasoline and antifreeze hung over the scene.

"She's going to have the baby before we can get her out Doc!"

"The hell she is! Ma'am, stop pushing. Keep that child inside you."

"I can't, it's twins......" she cried.

Sometimes when things just can't get worse, they do. I stretched my stethoscope forward to try to hear fetal heart tones above the rumble of the jaws of life. It was a futile effort, but it did have the effect of calming the trapped woman. "You will keep your babies inside," I told her. That's when her eyes rolled back and her body began to tremble. She was seizing.

"Get her valium," I heard somebody say.

"No! Get mag sulfate!" I commanded. As I drew up an intramuscular bolus of the stuff, a wave of trepidation washed over me. I was responding on labor and delivery instruction I had received a decade previously. I leaned into the vehicle, pulled the woman's butt cheek laterally, and slammed the 18 gauge needle I was given home.

I was pulled back as several firemen clambered onto the automobiles and began peeling the roof back like a sardine can. I watched as the woman's trembling subsided. "Just keep those babies inside....." I whispered.

I could do nothing further, so I went to check on the bloodied grandmother to be who had been driving her daughter to the hospital. She had superficial wounds and I pulled Kerlix from my bag to dress them. When I looked back to the wreck, the woman was being lifted to a stretcher. "Start a mag drip," I called out, as I went back to assist. The woman was loaded into the back of the waiting ambulance, and her mother into a police cruiser to follow her to the hospital. I was left at the scene of carnage with the police officers and firefighters. I looked over at the cursing man, still handcuffed prone to his backboard. An officer saw me looking at him.

"The son of a bitch tried to run away," he said.

"Am I needed for anything else?" I asked.

"Just your name. You work at the hospital?"

"Yeah."

As I drove home in my greasy bloody green scrubs, I marveled at the human mind. I had delivered two babies previously. I had dealt with seizures. I had never done both simultaneously. The knowledge of magnesium sulfate had been stored away in some pigeon hole of my mind until it was needed. It had been passed on only in lecture, and perhaps, it had shown up on a test in nursing school. I no doubt studied it. I filed it away in my mind and forgot about it. Yet, when I needed it, it was there.

It has been said that in times of uncertain crisis, a man will not rise to the occasion, but will instead revert back to his level of training. Nursing students often feel overwhelmed with information during their training. At one time, I doubted that I could ever retain all that was shoved into my head in nursing school. After I saw two twins in the nursery the next day, I never doubted it again. You do what you can. You try.

Off Call

It's been a tough on call weekend. From Friday afternoon to this morning I spent 34 of 60 hours in the hospital. Sometimes I wonder why I even come home. I was glad to finally be going off call and off work this afternoon at 3:00. At least I don't have another call weekend this month......... I hope.

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