Monday, April 13, 2015

Why Nursing Is Stressful


A hospital supply room. Shelves line the walls, full of medical equipment. A handwashing sink is against one wall. An electronic medication cabinet stands on the other side of the room. One NURSE is standing at the cabinet, doing math on a handheld calculator.

Enter an orthopedic RESIDENT, carrying a plastic bucket.

Resident: Hi there.

Nurse: (distracted) 'Morning, doc.

Resident: Where can I dump this?

Nurse: What is it?

Resident: Leftover plaster. I just finished the cast in room three.

Nurse: Oh. Just leave it there. I'll take care of it.

Resident: (noticing the sink) Can I dump it in here?

Nurse: (paying attention now) No, that sink can't take it.

Resident: So what should I do with it?

Nurse: Just leave it there. I'll take care of it.

Resident: Just leave it?

Nurse: Yes, please. I'll get to it in a minute.

Resident: It's leftover plaster. We just put a cast on in room three. Can't I just dump it in here?

Nurse: No, it'll clog the pipes. We add a hardener to it and then throw the whole bucket in the trash.

Resident: Really.

Nurse: Yes. I can show you, if you like, as soon as I finish this.

(NURSE tries to go back to doing math. He is interrupted before he can find his place.)

Resident: So where should I put the bucket?

Nurse: Just set it down in the corner.

Resident: Can't I just dump it in the sink?

Nurse: No, you can't, sorry. It will clog the pipes. Last time somebody did that, engineering had to replace some of the plumbing.

Resident: Are you sure?

Nurse: Yes. You can see where they cut a hole in the wall. We couldn't use this room for two days.

Resident: I've never seen that happen on the ortho floor.

Nurse: You don't pour plaster in the sink up there. They have a special drain for it.

Resident: Oh, yeah, right. So can I use this sink here?

Nurse: No. Our plumbing can't take it.

Resident: Are you sure?

Nurse: Yes, I'm sure.

Resident: I'm just going to pour it in here.

Nurse: Please don't!

(RESIDENT pours the plaster in the sink)

Resident: What should I do with this empty bucket?

Friday, April 10, 2015

Lead A Horse To Water

Here's the text of a note I entered in a chart:
Patient refused placement of Foley catheter. Patient also refused to use urinal while in bed. Patient stated he intends to stand up to urinate. 
This RN and Dr. Foramen educated patient about the severity and instability of his neck fracture, that the external cervical immobilizer does not provide complete protection, and that attempting to stand or walk in his current condition presents a very high likelihood of spinal cord injury leading to death, nerve damage, loss of function, paralysis, organ dysfunction, or death. Patient verbalized understanding of these risks, and further repeated his adamant intention to stand and ambulate against medical advice.
(My nursing notes are professionally polite. What the patient actually said was, "I understand you, but I don't fucking care. I don't piss lying down unless I'm blackout drunk, and nobody is shoving anything up my dickhole. I'm standing up whenever the fuck I want. Pardon my fucking French.")

Profanity notwithstanding, this patient was in his right mind and in full possession of his faculties. He had no head injury. He was not mentally ill, confused, nor delirous. He wasn't even drunk (anymore). We did not have any justification to physically or chemically restrain him against his will. So, we very carefully documented that we educated him, and we asked him to sign a paper which listed the risks. Then we had to let him make his own choices.

I don't think he harmed himself the first time he stood. When his knees buckled, we carefully caught and supported him before he could fall. But if he keeps trying to move around before surgery, the fragments of his shattered cervical vertebrae will shift positions, and he'll wreck his spinal cord beyond what the neurosurgeons are able to repair.

And there's nothing I can do about it.

Wednesday, April 1, 2015

Third Base!

At about two this morning I finished a run of many evening shifts in a row. On the way home I stopped at the all-night grocery store, and among all my other purchases for the week, I thought it appropriate to buy a six-pack of beer.

When I got to the checkout, the cashier took the beer off the belt and stuck it behind the counter. I was surprised, and I asked why he did that. We had the following exchange:

Cashier: "I can't sell alcohol right now. Sorry. It's after midnight."

Me: "Okay. When can I buy it?"

Cashier: "You can't. It's too late. It's after midnight."

Me: "You said that already. But when can I buy it?"

Cashier: "You'll have to come back tomorrow."

Me: "I can't buy beer until Thursday?"

Cashier: "No, Wednesday."

Me: "Today's Wednesday."

Cashier: "No, today's Tuesday."

Me: "Not anymore."

Cashier: "I don't mean to contradict you, sir, but I think I know what day I go to work."

Me: "You went to work on Tuesday. But now it's after midnight."

Cashier: "That's what I said. I can't sell alcohol after midnight."

Me: "I understand that. I want to know what time I can come back and get it."

Cashier:  "Like I said, not until tomorrow, which is Wednesday."

Me: "Fine! What time tomorrow?"

Cashier: "Any time, as long as it's before midnight."

Me: "Any time before midnight."

Cashier: "Yes."

Me: "How long before midnight?"

Cashier: "Doesn't matter."

Me: "How early in the morning?"

Cashier: "As early as you want."

Me: "But it's early in the morning right now. If the time doesn't matter, then technically it's before midnight, too. Like twenty-one hours before midnight."

Cashier: "Look at the clock, sir. It's three a.m. It's not before midnight. It's after."

Me: "Is this some kind of an April Fools joke or something?"

Cashier: "No, sir, April Fools is tomorrow."

I opened my mouth to try and keep arguing, but I decided was too tired and life's too short. I just abandoned my stuff on the counter and came home. I never did get my beer, but I've broken out the bottle of the good Scotch, because after that conversation I feel even more like I want a drink..

And I honestly have no idea whether the guy was joking.