Those folks you think are weird? They just operate from a different set of instructions. They're internally consistent -- and right much more often than you think. No, I'm not "sucking up", I'm learning about THEIR database so I know how to negotiate with them instead of fighting. This isn't about me, it's about that baby in the bed.
Difficult? Them? Some of you folks make them look like angels. Unfortunately some of you folks also provoke bad behavior from them. Difficult? You haven't seen difficult until you've taken care of MY family. Just ask the HMO answer nurse who ignored my mom. Ask the interns and medical students who were involved with my husband's care when he had surgery. Ask the poor suckers who got stuck with me when I had surgery a few years back. Difficult? You don't know how lucky you are.
Negotiating instead of bullying, there's a concept. Did you notice that they've gotten more compliant with the plan of care? Did you notice that the baby is gaining weight now? Did you notice that she's doing better?
No it's not always easy, but the baby is winning. Besides, I've found that the parents are interesting, intelligent people with some ideas that could make for better care for some of our other patients. Yes, I know some of you have always thought I'm a little weird too.
Monday, July 25, 2005
Note to self
1. Check the gmail account.
2. Make a note of your password. Your brain is like a sieve some days.
2. Make a note of your password. Your brain is like a sieve some days.
Thursday, July 21, 2005
IV therapy escapades - part I
Things have been blessedly uneventful in the NICU lately. The census was down to 10 last weekend and the babies are all doing well. I could tell old NICU stories, but instead, I think I'll share a few of my IV therapy moments.
A long time ago, in a hospital not so very far from my home, I took a PRN position as an IV therapy nurse. That means whenever they had a need and I had a few spare hours, I'd go do some stick-and-runs, change a few central line dressings, assist with central line placements, and generally lighten the load on the regular staff so they could do things like teach people how to care for their implanted venous access devices (Ports and Hickmans, mostly) once they got to go home with them.
As you doubtless know, patients have the right to refuse pretty much any intervention - provided they're competent to make that decision.
The patient's IV had infiltrated and the staff was waiting for me to restart it. I soon found out why they hadn't tried themselves. I didn't even get a chance to introduce myself when the man announced, "If you try to stick me with needles, I'm going to hit you!" As a rule, I'd just document the refusal and go on to the next patient, but I wasn't entirely certain that this patient was competent to make that decision. I was in no mood to find out if he meant what he said about hitting so I quickly made a U-turn and found his nurse. She assured me that he had been evaluated by the psych folks, that I could legally restart the IV without his consent if necessary, and that she'd find me some help to restrain him.
The help didn't look substantial enough to keep me from getting hit - and I really prefer the cooperation of the patient in any case. When I re-entered the room, I explained that Dr. "X" really felt that he needed his IV and that I didn't care to be hit. I suggested that instead of hitting, he could share his feelings about the procedure - in whatever vocabulary suited him.
He was quite cooperative after that. He spent the next 5 minutes telling me in very colorful language exactly what he thought of the hospital and of the nurses who'd been caring for him -- and Dr. X. He didn't swing at me, though. In fact, he held his arm quite still and even thanked me before I left.
A long time ago, in a hospital not so very far from my home, I took a PRN position as an IV therapy nurse. That means whenever they had a need and I had a few spare hours, I'd go do some stick-and-runs, change a few central line dressings, assist with central line placements, and generally lighten the load on the regular staff so they could do things like teach people how to care for their implanted venous access devices (Ports and Hickmans, mostly) once they got to go home with them.
As you doubtless know, patients have the right to refuse pretty much any intervention - provided they're competent to make that decision.
The patient's IV had infiltrated and the staff was waiting for me to restart it. I soon found out why they hadn't tried themselves. I didn't even get a chance to introduce myself when the man announced, "If you try to stick me with needles, I'm going to hit you!" As a rule, I'd just document the refusal and go on to the next patient, but I wasn't entirely certain that this patient was competent to make that decision. I was in no mood to find out if he meant what he said about hitting so I quickly made a U-turn and found his nurse. She assured me that he had been evaluated by the psych folks, that I could legally restart the IV without his consent if necessary, and that she'd find me some help to restrain him.
The help didn't look substantial enough to keep me from getting hit - and I really prefer the cooperation of the patient in any case. When I re-entered the room, I explained that Dr. "X" really felt that he needed his IV and that I didn't care to be hit. I suggested that instead of hitting, he could share his feelings about the procedure - in whatever vocabulary suited him.
He was quite cooperative after that. He spent the next 5 minutes telling me in very colorful language exactly what he thought of the hospital and of the nurses who'd been caring for him -- and Dr. X. He didn't swing at me, though. In fact, he held his arm quite still and even thanked me before I left.
Saturday, July 09, 2005
The world is spinning a little faster
I got up on Wednesday and found that I couldn't quite keep up. Everything was spinning a little faster than usual. Blood sugar normal, blood pressure normal, no arrhythias even after a cup of coffee.
My head was a little stuffy, so I took some pseudoephedrine hoping it would help. Not much. I staggered through my day - including the retirement party for my husband Wednesday night.
Thursday, things hadn't slowed down, so I had my husband drive me to the doctor for a prescription which has slowed things a little. They had the CNN feed on there, covering the terrorist attacks on London. That certainly put my little inconvenience into perspective.
I got home and a friend had forwarded the email about the folks who survived 9/11 because of some minor "inconvenience". I'm sure you've all seen it. I usually grumble and delete things I've seen that many times, but it touched me that day in a way it had not previously.
Next, I checked a message board with a multinational presence to be certain that my friends there were safe. All were - and one had a brother-in-law who'd hadn't been in the World Trade Center on 9/11 because a meeting had been cancelled. This time, he decided at the last minute to telecommute. As someone there said, we're happy that her brother-in-law is safe, but saddened that someone's isn't.
My condolences to the people of the UK and to everyone who has lost friends or family in this assault on humanity. I'm a little late, but response to the suggestion at A chance to cut is a chance to cure I'm flying the Union Jack. I wish I'd thought of it myself.
Monday, July 04, 2005
Den Leader
Last week was Cub Scout Day Care week in our district. Officially, it's Day Camp, but many of the parents seem to believe that the requirement that they contribute some of THEIR time to the project is unreasonable. As a result, it's a struggle to come up with the 2-deep leadership required by BSA to protect the kids.
Why 2-deep? First, of course, having a second adult around provides a witness that the first leader didn't abuse or molest any of the kids. Second, it might just help to prevent any such abuse. Third, and perhaps more important, having 2 adults with each group of cubs means that one adult can deal with any emergency -- bleeding, fracture, seizure, allergic reaction, etc. -- while the other deals with the rest of the cubs and obtains any needed assistance.
Now that I've vented, I have to admit that I had a good time last week. This was my youngest son's third and final year as a Cub at Day Camp because he'll be a Boy Scout next summer. He may go back as a camp aide, but never again as a Cub. He begged me to be his den leader this year. I've always done something else at Day Camp and missed out on seeing his accomplishments. Not this year.
It was great to be there when he scored bulls-eyes on the BB and Archery ranges. He was happy that I was there when he singed his finger at the wood burning station and I was glad I'd served a term as camp nurse, so I was well practiced in saying "Yep, that's going to hurt for a while" without tears.
I feverishly searched the internet for skits only to find that my own Cub has a real penchant for adapting them to fit his den and his Day Camp. The skit was such a hit that his den mates wanted an encore.
I was exhausted by the end of the week, but it was a good tired. I had fun with the kids. I think I taught them a few things and I know they taught me a great deal. The parents who opted not to share this week with them have no idea what they missed.
Why 2-deep? First, of course, having a second adult around provides a witness that the first leader didn't abuse or molest any of the kids. Second, it might just help to prevent any such abuse. Third, and perhaps more important, having 2 adults with each group of cubs means that one adult can deal with any emergency -- bleeding, fracture, seizure, allergic reaction, etc. -- while the other deals with the rest of the cubs and obtains any needed assistance.
Now that I've vented, I have to admit that I had a good time last week. This was my youngest son's third and final year as a Cub at Day Camp because he'll be a Boy Scout next summer. He may go back as a camp aide, but never again as a Cub. He begged me to be his den leader this year. I've always done something else at Day Camp and missed out on seeing his accomplishments. Not this year.
It was great to be there when he scored bulls-eyes on the BB and Archery ranges. He was happy that I was there when he singed his finger at the wood burning station and I was glad I'd served a term as camp nurse, so I was well practiced in saying "Yep, that's going to hurt for a while" without tears.
I feverishly searched the internet for skits only to find that my own Cub has a real penchant for adapting them to fit his den and his Day Camp. The skit was such a hit that his den mates wanted an encore.
I was exhausted by the end of the week, but it was a good tired. I had fun with the kids. I think I taught them a few things and I know they taught me a great deal. The parents who opted not to share this week with them have no idea what they missed.
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