Thus I created this diagram to help in my analysis of the siutation (and yes, the etc. in the middle worries me just a little):

After due consideration, my conclusion: clearly, the husband must go.

I spent the better part of Friday preparing to get drunk, and then, in fact, getting drunk. Far, far too drunk. This is funny, because I never drink, being the soul of moderation.

Saturday was the day after the night before.

Sunday I nearly went to church, but didn’t because I procrastinated till it was too late to go (I was writing a blog post, actually), and then I went shopping. I know I’ve said I’m a Christian and so on, and Christians are not supposed to drink to excess and even Sunday shopping is a little frowned upon — but I never said I was a good Christian. I’m hardly even a mediocre Christian. Too mouthy. Anyway, I also went to my new favourite all-you-can-eat sushi restaurant, perhaps to soothe the guilt of not doing my religious duty. I am a little embarrassed to relate I’m eating there so frequently the owner has given me a little card making me a “V.I.P customer” which entitles me to 10% off lunch and dinner. Last time I went he gave me a plate of delicious steamed mussels though they aren’t on the all-you-can-eat menu. This worried me, a little. When a man gives you a plate of steamed mussels in front of your husband, I think there is something going on. I was quite anxious about this. Would he repeat his free mussel performance? I glanced nervously toward the kitchen every few moments. I felt as though God was punishing me by wrecking my lunch. However, there were no further mussels.

Monday, I took  friend and her diabetic cat to the vet, then ended up shopping some more, which is very surprising, because I loathe shopping the same way some people loathe Justin Bieber. Incidentally, I saw his doll at 50% off. We intended just to run into the mall “for just a minute” at 1115 and stayed so long our planned lunch metamorphosed into supper.

Filed under the category of It Seemed Like a Good Idea at the Time is the fact that I’m working four day shifts in a row beginning today.

All of which is to say, posting may be light and insubstantial over the next few days. I don’t even have any ideas for light and insubstantial posts. I have no blog posts written in advance. I used up my emergency reserve post a couple of weeks ago.  My brain has gone on vacation.

I am a bad blogger.

I hang my head. In shame.

And no, I don’t want any demented emails explaining Jesus really didn’t mean what’s plainly in the Gospels.

[Via]

off.

Lest you think the satire is a little harsh, or if you get warm fuzzies donating to pink ribbon campaigns, consider that corporations jumped all over pink ribbon campaigns not just because of their intrinsic worth, but more importantly, because it’s a “safe”, non-controversial issue, and more to generate profits. Think Before You Pink, an advocacy website, makes a necessary corrective:

She and the Times agree on the source of the disease’s peculiar popularity in corporate America. It is a quality that the breast cancer awareness ribbon both captures and enables. “Companies want to support breast cancer,” Cone says simply. “Breast cancer is safe.”

Unlike AIDS, breast cancer is free of what companies euphemistically call “lifestyle issues.” And, perhaps as importantly, breast cancer provides charitable credentials for what can be a very small investment. With the ribbon’s message of ”awareness” translating most often into a familiarity with early detection techniques, all a company has to do, to do good, is put a ribbon on its merchandise.

New Balance, for example, donates money from the sale of its Race for the Cure caps, socks and T-shirts to the Komen Foundation, but its pink ribbon sneakers, a Foundation spokesperson says, are ”just for awareness.” The sneakers have the tiny pale-pink outline of a ribbon sewn onto the corner of their tongues—difficult if not impossible for anyone except the owner to see. The possibility that those two wan loops might remind woman to get the mammogram that saves her life, however, provides the sneakers with their raison d’étre.

It is this dynamic that drives the pink ribbon’s detractors to distraction. “There is a value to awareness, but awareness of what, and to what end?” asks Barbara Brenner, activist and executive director of Breast Cancer Action (BCA) in San Francisco. “We need changes in the direction the research is going, we need access to care—beyond mammograms—we need to know what is causing the disease, and we need a cure. The pink ribbon is not indicative of any of that.”

Check out the website’s list of questions to consider before buying pink.

Also this stupidity:

Kouris’s 83-year-old uncle is one of 11 seniors with dementia who are set to be moved to Sudbury after their mental health centre merges with a new hospital and loses beds in January.

The list of those being moved is constantly changing as the patients improve or worsen, and some could learn at the last minute whether they get to stay or go, a hospital spokeswoman says.

The 130-kilometre distance between North Bay and Sudbury makes it hard for family members — many who are seniors themselves — to make the trip.

I get that the LHIN makes the decisions about bed allocations, but this isn’t Toronto, where shifting beds around makes little difference for access. 130 kilometres in the winter. Frig.

And also, the Double Down makes its appearance in Canada, because, clearly, another fast food item loaded with salt and saturated fats is indicated in a market starved of fast food items loaded with salt and saturated fats. KFC is choking a little on the marketing:

Even KFC doesn’t recommend having the sandwich too often.

Dan Howe, chief marketing officer for Yum! Restaurants Canada, which operates KFC, says the sandwich is a quote — “occasional, indulgent” eat.

Do KFC outlets have automated external defibrillators, you know, for people who overindulge? Just asking.

***         ***          ***          ***          ***

I also note that there’s been — well, not a flood, but definitely more than a rainfall that blocks up the storm sewers — of new readers here lately, and I thought I would remark on my blogging particularities and eccentricities, so no one is surprised, ‘k?

1. I post something daily, except when I don’t.

2. When I don’t post, it’s because I’m doing something else, like working or not writing. Or tending to the husband. Or writing something non-blog related, or simply because my brains are running out of my eyesockets trying to think of a clever and concise way to relate the chaos, funny and serious that usually surrounds me. If I fail, you will read me whine about it, forcefully, the next day.

2. Saturdays I usually post poems. And photographs.

3. Personal writings that some deluded people call “poetry” are liable to appear without notice.

4. Pictures of the cat are liable to appear, again, without notice.

5. Sundays I try to post something portentous.

6. I will post a list ‘o links if I am pressed for time, or (more likely) have nothing to say. These tend to be irregular.

7. More personal details can be found here.

The trouble is, I think if I ever see some guy wearing these, say, in a trauma, I’m going to get an irreversible case of the giggles. I’m giggling, in fact, as I write this. Also, why do I think guys who would parse their underwear would have these?

Available, if you’re interested, through Marks & Spencer.

[via Sabina Becker and Roger Ebert]

20-something guy arrives via EMS for a penile fracture. (How he fractured his penis — well, it’s a story Not Suitable For Work, though suffice to say, it involves repeated dosing of beer and shots.) Granted, it’s a horridly painful injury, and a true urologic emergency: I guarantee all of my male readers are wincing and all of my female readers are snickering. However, our buddy is drunk and carrying on far, far beyond the call of duty, thrashing around and fluently and imaginatively cursing out the paramedics, the housekeeper, the nurses, the physicians, anyone, in fact, within earshot or seen from beery, bloodshot eyes. He’s not only an caterwauling idiot, but something much worse, a drunken, caterwauling idiot.

Triage listens to the (slightly ridiculous) story from EMS, listens to the continuous, matchless bellowing on the EMS stretcher, and pronounces her verdict:

“Clearly,” she says,  ”A brain injury.”

A team from Imperial College London said that cardiovascular risk associated with the fat content in a 7oz cheeseburger and small sugary milkshake could be cut by giving customers statin pills at the same time.

At less than 5p [8 cents] per pill – the same as a portion of ketchup – the researchers said the plan would be a cheap way of combating the negative health effects of junk food in the same way that smokers are offered filters and drivers must wear seatbelts.

Youngish Woman: (overly distraught) The room started spinning, and I started feeling all weird ‘n’ stuff, and lightheaded, and I don’t know what’s wrong with me! Also, I got really really hungry!

Boyfriend: We were smoking marijuana.

Triage Nurse: Isn’t that the desired effect, guys?

So can it get any better than a “nurse” robot that looks like a teddy bear?

Probably not.

Dr. Weanus feels it is his duty to point out errors in the charting, which he likes to point out with the glee of a child finding an Easter egg. Oh look! She wrote in the chart, an official legal document, “nauseous” not “nauseated.” She used “emesis” instead of “vomitus”! Distinctions without a difference, yes, but precision must be our watchword!

And then he comes to an error so egregious he must bring it to the charge nurse for rectification.

He hands me the chart on a 55 year-old Upper GI Bleed.

He points to the offending word. “Coffee-ground.”

Let me pause here. “Coffee-ground” as in “coffee-ground emesis” refers to the appearance of a particular sort of vomitus — it literally looks like coffee-grounds. It strongly suggests gastric bleeding. More to the point, it’s been a descriptive term used by nurses and physicians alike since, well, people began to drink coffee.

So I ask, what’s wrong with “coffee-ground”?

“It means the patient is bleeding! We don’t actually know that! This is unacceptable!”

Uh, actually, no. It’s a descriptor, not a diagnosis.

I catch myself before I can fully roll my eyes. What would you call it, Dr. Weanus?

“Well-cooked ground beef!”

That’s much better. Thank you Dr. Weanus!

Can anyone really say? So he pours over the chart, stroking his chin thoughtfully: what does the radiologist mean exactly, when he sees a slight opacity in the chest x-ray? Why it means I will have to order —

And then, alas, tragedy. He is interrupted. What brilliant thought, what insight is lost forever we can only guess — and worse, he is interrupted by a nurse!

A nurse!

“About that palliative patient in Exams you were supposed to see —”

Dr. Weanus erupts. He is incandescent. He positively glows in Outraged Physician Radiation. How dare you? he shouts. Who referred this so-called patient? I spoke to no emergency physician! This is a gross violation of procedure! I categorically refuse to see this patient!

” — she died.”

He waves a hand dismissively. “Oh, that’s all right then,” he says.

Head down, back to the chart, cheerful even.

My favourite internist.

__________

*OHIP: Ontario Health Insurance Plan, i.e. who pays Ontario physicians.

Venkat Milligan, 22, pleaded guilty Monday to drug trafficking and weapons charges after police found a loaded 9 mm Keltec pistol wrapped in a sock next to his bed at St. Michael’s Hospital.

Officers also seized 6.5 grams of crack cocaine, a quantity of marijuana, 99 hits of ecstasy, an electronic scale and a bulletproof vest from his room on the 14th floor at the downtown hospital, Crown attorney John Healy told court.

At the rate the housekeepers lose reading glasses and dentures, I’m surprised the pistol didn’t end up in the hospital laundry.

Youngish Female Patient: (at Triage Nurse) Do you have to go to school to do this?

Triage Nurse: Ummm. . .

Youngish Female Patient: Do you get to hook up with the doctors?

Triage Nurse: (makes retching noises)

***         ***          ***          ***          ***

Overheard at Triage:

New Paramedic: (to Triage Nurse, excited) We have a new onset CVA* here, 49 year-old female, slurred speech, ataxia, and decreased LOC†. You guys going to call a Code Stroke?

Triage Nurse: Okay. So what’s the story?

New Paramedic: Her husband says she was drinking today, and then he found her like this about an hour ago.

Triage Nurse: Waiting room, boys, and thanks.

__________

*CVA: Cerebral Vascular Accident, i.e. a stroke.

†LOC: Level of Conciousness.

Sean, evidently, has too much time on his hands.

Sinus rhythm

–~-V-~–~-V-~–~-V-~–~-V-~–~-V-~–~-V-~–~-V-~–~-V-~–~-V-~

Sinus bradycardia

–~-V-~——–~-V-~——–~-V-~——-~-V-~——–~-V-~——-~-V-~—

Ventricular tachycardia

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Sinus tachycardia

~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~

Paroxysmal Supraventricular Tachycardia

–~-V~–~-V~–~-V~V~V~V~V~V~V~V~V~V~V~

Supraventricular Tachycardia

~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V

Adenocard

~V~V~V~V~V~V~V~V~V~————-ohshit———~V~–~V~–~V~–whew

Multifocal Premature Ventricular Complexes

–~-V~–~-V~–~-V~W–~-V~M–~-V~W–~-V~M–~-V~

Unifocal Premature Ventricular Complexes

–~-V~–~-V~M–~-V~M–~-V~–~-V~–~-V~M–~-V~

Ventricular Bigeminy
–~-V~M–~-V~M–~-V~M–~-V~M–~-V~M–~-V~M–~-V~M–~-V~

Atrial Fibrilation

~~~V~V~~~~~~V~V~~~V~~~V~~~~~~V~~V~V~VVV~~~~V~V~

Premature Atrial Complexes
–~-V~~V~–~-V~–~-V~–~-V~~V~-~-V~–~-V~-~V~-~-V~

Atrial Flutter (3:1 conduction)

vvvVvvvVvvvVvvvvVvvvvVvvvVvvvVvvvVvvvVvvvVvvvV

1st degree heart block:

-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~-~—V~

2nd degree heart block, type 1 (Wenkebach)

—~V~–~-V~-~–V~~—V~~———–~V —~V~–~-V~-~–V~~—V~~———–~V

2nd degree heart block, Type 2

–~-V~–~-V~–~-V~–~——–~-V~–~-V~–~-V~—~———~-V~

3rd degree heart block

~V—V-~-V–~V—V~–V-~-V–V—V~–V-~-V–~V

Pacer rhythm w/ capture

–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~–|W~

Ventricular Fibrillation

wWwWWWwwWwWvVVvwMMwMMmmmvvvMM

Defibrillation w/ conversion

MmwVwMmwwvvVWMCLEAR!<>BLAM<>——~V~–~V~–~V~–~V~–~V~–~V~–~V~

Synchronized cardioversion

`V`V`V`V`V`V`V`V`V`V`V`V`V`VCLEAR<>BLAM<>–~V~–~V~–~V~–~V~–~V~–~V~–~V~–~V~

Atropine

———-~-V~———-~-V~———-~-V~–~-V~–~-V~–~-V~–~-V~–~-V~–~-V~–~-V~

Asystole

————————————————————————–

Epinephrine

———————————————-~-V~–~-V~–~-V~–~-V~–~-V~–~-V~–~-V~–~-V~–~-V~

A-fib with RVR

~~V~~V~V~~V~VV~V~V~~V~V~~V~VV~V~V~~V~V~V~~V~~~V~V

Sinus pause

–~-V~–~-V~–~-V~———-~-V~–~-V~–~-V~–~-V~———–~-V~–~-V~–~-V~–~-V~–~-V~
Cardizem

~V~~VV~V~V~~V~VV~~V~V~V~~V~V~~~~V~~~~V~~V~~~V~V~~~V~~~~V~~V~~~V~~~~V~~~V~~~~V

Torsades des pointes (French accent mandatory)

VVVvvvVVVVvvvvVVVVvvvmmmMMMmmmMMMvvvVVVvvvVVVmmmMMMmmmvvvVVVvvv

What more can I say?

Looking at him now, he’s a punk with an admittedly engaging smile. And why was he being chased with a wrench, anyway?

More philosophically, were we ever that young?

And my conclusion about the culture of the Eighties? Ultimately, it was about Big Hair, and lots of it.

In the middle of this Sturm und Drang I cheerfully, irreverently pointed out the day was Nightingale’s birthday. Hurray for Us!

Groans. Then Triage walks by.

“Great,” she says. “Now we have someone to blame for this shit.”

Before all of that, however, we were treated to the usual ACLS training videos, produced by the American Heart Association. If you have done ACLS you know the ones I mean, with the guy in the blue shirt (more about him in a moment), and the actors with thick Texas accents.

The videos were new the last time I recertified, and I had forgotten how ridiculous they were, not in their content, but in their Sixties-throwback portrayal of nurses and the hierarchical relationship between physicians and nurses. Or maybe it’s an accurate representation of nursing in Texas?

Sample dialogue (I’m doing this from memory, so please excuse any errors):

Physician: (slowly, as in patiently instructing a dim child) Julie, would please begin the preparation for this patient for Percutaneous Coronary Intervention, alert the catheterization team, and obtain a consent? Please also obtain an EKG and place this patient on a cardiac monitor, and report to me with vital signs every fifteen minutes.

Nurse: (head bowed and eyes downcast, literally) Yes sir!

I nearly fell out of my chair, watching this, but my dropping jaw was in the way. In my universe, any physician behaving like this jackass would have been so much mirepoix as sliced and diced by Julia Child. Maybe when the portrayal of nurses as stereotyped brainless wonders distracts from the information you’re trying to convey, it’s time to revamp.

Anyhow, as we watching these awful videos, a close colleague and friend who was recertifying with me and who also is very evil, nudged me in the ribs.

“What?”

“Look at the guy in the blue shirt,” she whispered.

I looked. “What?”

“His left eye, it’s wonky.”

I looked again, and so it was. Unfortunately, it was one of those things that once you notice it, you can’t take your eyes off it and worse, you can’t help yourself. Once you see the wonky eye, it’s all you can see.

It’s at 00:49, in case you want to see for yourself, and taint every ACLS course you ever do. You’re welcome. I live to serve.

__________

*Where the victim, i.e. the student, is given a scenario, and the examiner then runs through a variety of cardiac arrhythmias in order to test how the student would treat each arrhythmia.

A back-of-the-envelope calculation of nutritional value shows an astonishing 1366 calories and 36g of fat — excluding condiments. I’m guessing anyone who finds this appetizing is already on metformin and a calcium channel blocker.

Or Homer Simpson:

[Homer gasping for air due to being so out of shape]

TV Announcer: We take eighteen ounces of sizzling ground beef, and soak it in rich, creamery butter, then we top it off with bacon, ham, and a fried egg. We call it “The Good Morning Burger”.

[Homer starts gurgling in ecstasy]

(The Simpsons “Bart’s Friend Falls in Love”, 1992)

Life imitating art, or what? Or reality catching up to satire?

My reaction: Meh.

Part of it was that it all seemed a bit formless. Then there were the faux bits of magical realism, thrown in, one suspects, for the sake of trendiness. And what about verisimilitude?

Let me demonstrate à la Perez Hilton:

Look, if you’re gonna spend a gazillion dollars ensuring high production values, at least shell out some cash to buy some half-decent Littmans.

Geez.

Also, in medical dramas, is it actually possible to have an ugly resident? Hell, I’d settle for an average looking one.

Much mirth, all in completely adolescent bad taste, ensues. Is there any other in the Emergency? A patient or family member, clad in Middle Class Canadian Suburban Winter Attire, overhears us a little and waxes indignant. She marches up the to the nursing station, and announces, “You are being. . .”

A pause while she searches anxiously for that particular damning word

“. . .unappropriate!”

Which provokes more unappropriate laughter after she haughtily stomps off. Of course, we’re being unappropriate. No doubt about it. It’s a truism emergency staff, nurses and physicians alike, have a wicked black sense of humour, explained away by the uncontrollable stress we face. Regular readers have seen numerous examples of it on this very weblog. But like any truism, it needs some examination. It’s true emergency staff use humour to blow off steam. Some of the funniest one-liners I have heard have been uttered while body-bagging the particularly difficult, tragic, and ultimately unsuccessful code. It’s a coping mechanism. We have to laugh, lest the awful meaninglessness of it all overwhelms us.

But there are other reasons. You have to see any emergency department as a kind of pressure cooker, where egos as toothsome as sharks swim the corridors, with its own peculiar culture, jargon, ritual, etiquette and notions. Those new to the emergency are sometimes overwhelmed by the intensity. Humour allows newcomers to be socialized to emergency department esoteria, to share in its particular mores. It helps them to become one of us. And among the veterans, it sustains a sense of cohesion when times are tough, tempers flare, and tension runs high. In short, humour keeps us from feeding on each other.

All humour requires a theme and stock characters. The general theme — with variations — in emergency department humour is Our Unending War with Human Stupidity, the narrative features our own cleverness in dealing with the stupid, the stock characters typical: the Drug Seeking Individual, the Foreign Body in Unlikely Places, the Muffin in Distress, the Drama Queen, the Nursing Home Dump, the Too Stupid to Live, the HBD and Went Boom. But there is danger in creating the Us-and-Them mentality implied in warfare, because it also implies treatment and care according to our subjective whims. Labels and caricatures deceive and misrepresent, when what is needed is accurate assessment. The Muffin in Distress, after all, might be a septic gallbag; the Drama Queen, an ST Eelevation MI; the HBD, a cerebral bleed. Most of us, it’s true, work beyond the labels, and treat the patient, not the caricature. But we have all seen cases where the opposite was true.

Yet unlike hospital administrators or professional regulatory bodies or other bloodless types, I cannot pass judgement. I use humour myself. I am, at times, irredeemably unappropriate. But sometimes, life in the emergency department sucks, and in ways unimaginable to most people. To use a catchphrase, embracing the suck allows us to do our jobs.

Anyway, some free and completely unsolicited thoughts on nurse uniforms, just to throw a little gasoline on the fire.

1. White is dead. Deader than Florence Nightingale. More out of date than IV theophylline. Sorry. It’s ugly, hard to clean, gets that dingy-grey colour, looks crappy on me, and did I mention it’s ugly? Also has unfortunate and disturbing overtones of the old nurse-as-physician’s-handmaiden-and/or-sex-toy meme. I think of nurses in white uniforms, and nursing caps, capes and Marcus Welby, MD come to mind. And the olden days when nurses would all stand when the physician came to the floor.

However in one hospital in the US has gone for that retro look:

Years ago, nurse uniforms were all white, very basic. Well, that look is making a comeback of sorts. This time at Heartland Regional Medical Center in Marion.

“The nursing staff went with white. Because how basic can you go back to then seeing a nurse in all white. It signifies purity and professionalism and caring and that’s what we’re about,” said surgical unit director Greta Smith.

I get the professionalism thing. But the purity angle? What the hell is that about? We’re pure of heart? We wash our hands? Morally pure? Have never known men carnally (or women, as the case may be)? Gratuitous aside: I often think managers tend to project their own neuroses into the policies they write.

2. On the other hand this I think is just plain silly:

I’m with At Your Cervix: if you are wearing cutey-bears — makes TowontoEmewg Fwow Up, it does — I cannot take you seriously. Unless you are a paeds nurse. (Frankly, even then I would be a little doubtful.*) Can you imagine explaining thrombolysis to your STEMI patient dressed in this? Personally, if I were the patient, I would either get the giggles or be very, very afraid. Because, as we know, nothing bespeaks competence in health care like teddy bears. Not to mention infantilizing the wearer, which brings us back to the basic problem with All White.

3. For my money, it’s got to be your basic solid colours. Nothing too frilly. No apple blossom pink, or anything like that. (See infantilization, above.) Even better, pick one colour to wear, all the time. Then you don’t have to worry about matching anything, and you don’t have to think about what your going to wear. Face it, you’re going to work in blood and faeces, not walking down the runway at Chanel’s spring show. Add stethoscope and name tag, and you’re Nurse Deluxe.

You’re welcome. You can direct hate mail/flames to my employer, Acme Regional.

__________

*Also, everyone always says it’s okay for paeds nurses to wear bears. Or what-have-you. Why?