The Sword

I just came from Maddog Medic's story about Bouncing Babies and Bleeding Heads. I do like happy endings. He reminded me of episode at my house several years ago.

I left my youngest son in the care of his older brothers (then teenagers) while I was taking a shower. As I was getting dressed, the little guy started pounding on the bathroom door:

"Mom! Mom! Big brother cut himself ..........


With a sword!


There's blood everywhere!


3 big puddles!


Needless to say, I wasted NO time getting downstairs where I found.........



Not a drop of blood anywhere and the 2 older boys sitting at the kitchen table calmly discussing whether or not they needed to call 911.


I made the mistake of peeking under the dressing covering the wound. No, that injury didn't need a 911 call, but mom very nearly did. The brother who controlled the bleeding and applied the dressing is now a student in the paramedic program at our local community college. The other one is barely has a scar, despite the many sutures required to close the wound, and he's still collecting swords - but he has learned to be VERY careful with the sharp ones.

Apology

I had to turn on word verification on my comments section. I was getting spammed. I know some people have difficulty with the word verification, but I was getting tired of deleting a comment seconds after posting.

I hope this works. I hope my spammer smashes his/her knee on a big rock very soon. It wouldn't hurt my feelings if s/he broke a wrist in the process. Both of them, even.

Transition

Double whammy Friday night: Charge nurse AND admissions. Sometimes it's entertaining.

The shift started with a bang -- 2 high risk deliveries. First one, no problem. Second one, C-section. Baby was nice and pink, but wouldn't stop grunting. In case you've been out of pediatrics for a while, that's a behavior newborns display when they're struggling to get or keep their lungs fully expanded. The nurses in the well-baby nursery, very wisely, will not accept babies engaging in this particular activity. We suspected that this baby was just slow making the transition from intrauterine to extrauterine life, but after 15 minutes of stimulating (making him cry), suctioning (also making him cry), and applying PEEP (positive end expiratory pressure to help expand the lungs -- and make him cry), we decided that we'd have to take him back to the NICU with us.

Once there, we made the baby cry some more by drawing blood to send to the lab. This is jokingly called a "theraputic" workup when the baby ceases all disturbing behavior (grunting) after being caused to cry so much. Net result, we had a CBC (complete blood count) which had some minor deviations from the norm (13 bands) and a baby who was, by then, asymptomatic. The neonatal nurse practitioner on call decided to repeat the test in the morning, but went to bed without actually writing the order and I hustled the little guy back to the waiting arms of his mom - still in the birthing center.

6 hours later, the first year pediatric resident covering the well baby nursery sauntered into the NICU in search of the nurse practitioner. He allowed as how he wasn't sure whether to wake her, since she attended the delivery, or his senior resident. On the advice of the NICU staff, he was about to go wake his senior resident when I thought better of that suggestion and asked him which baby was causing concern. Baby #2, of course.

Since his concern was focused on that CBC, I thought I could put his mind at ease by assuring him that the nurse practitioner had already decided to just repeat the test. He was almost convinced, but there were these complications:

The baby was still asymptomatic, but there were factors in the mom's history that worried him. Did he know something we didn't? After reviewing his list of concerns, we found only one thing the nurse practitioner hadn't known - but we really don't worry about abnormal pap smears. He's certainly thorough - and concientious. He even listens to nurses. I think he might be a keeper. Oh and he did go order that repeat CBC.

Spruce Lake Outdoor School

I spent 3 days last week enjoying the wilds of northeast Pennsylvania with my 10 year old. OK, it wasn't really very wild. We slept in beds and used flush toilets and ate food cooked in an actual kitchen, but it was fun - and very educational.

That body of water in the picture? It's the lake. That speck in the middle of the picture? If you look very closely, you'll see that it's a 10 year old boy wearing a harness and a helmet and flying over the lake on the zip line. I think it was the high point of the trip -- well, that and playing air hockey with a friend during his few free moments.

My son learned quite a bit about how deer impact their environment and about how farm land returns to its previously forested state over a period of many years. I learned that while I can keep up with 10 year olds for about 2 hours in the mountains, 3 hours is a little more than I can handle without more advance preparation (training). Tripping over that log didn't help much.

We also had great fun studying "Skins and Skulls" and doing a little forensic study in a CSI format (Critter Scene Investigation). My son made his first attempt at the climbing wall and was very proud that he made it halfway up. Next year, the ceiling!

I learned some new techniques for redirecting challenging 10 year olds which will come in very handy in my Cub Scout den this year. I also learned that bifocals are a BAD idea when walking on uneven ground. I've fallen several times since getting the bifocals. Two falls in 2 days finally got my attention. Call me a slow learner. My knee will recover, according to the orthopedist. He advised me not to fall on any more big rocks. He didn't even snicker when he said it. Maybe I should try knee pads while I'm waiting for the new glasses.

IV therapy escapades - part II (Uh-oh!)

Me: "Uh-oh."

Patient: "That doesn't sound good. What do you mean, uh-oh?"

Me: "Just a little tape sticking here, really no big deal"

Patient: "You need to be careful saying things like that when you're working on someone's central line."

Me: "Sorry. I'm used to the babies in the NICU. They don't notice things like that. Thank you for the reminder that adults can actually understand what I'm saying."

Patient: Laughs "Just don't do it again!"

That was my first day on the IV team. I saw him many more times in the 3 years I worked there - he was a regular, and always with a central line. He never let me forget that intro, either.

Note to my co-workers

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.

Note to self

1. Check the gmail account.

2. Make a note of your password. Your brain is like a sieve some days.