Saturday, October 28, 2006

Who are these other guys?

Aside from my dad, I wonder who these other guys are?
LogoThere are:
people with my name
in the U.S.A.

How many have your name?

Thursday, October 19, 2006

Beneficiary of kindness

Today started early. By 6:50 AM I stood waiting for a UT shuttle bus to take me to campus where I’d catch the Airport Flyer bus. A fellow male nursing student and I are attending the American Assembly of Men in Nursing 2006 Conference in Portland, OR. I was feeling a little stressed because the Cameron Road bus hadn’t arrived when a car pulled over. The driver rolled down the window asking, “Are you going to campus? Get in and I’ll drive you.”

Seeing as how she was an older woman, I wasn’t too worried about being kidnapped, robbed, and beaten. An offering of ribbon candy was possible, but as long as I demurred politely I figured I was safe. Throwing my bags in the back, I got in. Turns out she’s an English professor at UT and picks up students on her way to work all time. At roughly the same time every day, she drives along the Cameron Road route and offers a ride to whoever is waiting for a bus that early in the morning. Remarkable.

We chatted about my impending trip and she told me her great experience with the nurses that cared for her (several men among them) during a hospitalization. When we got close to campus, she asked me where I needed to go and I offered that she could drop me off where it was convenient for her. “I have a handicap permit dear, anything is convenient for me.” So I directed her to the bus stop. She wished me a good trip, I thanked her profusely, and that was that.

I’ve got to find a way to have her kindness recognized.

Monday, October 16, 2006

A great day as a nursing student

Yesterday afternoon I went to the hospital to pick my patient as I do every Sunday. This entails looking through patients' charts on the unit to which I'm assigned in search of one that would provide a good learning experience. I wanted this one patient I'll call Mr. B, but was told he'd be going to surgery in the morning and would be off the unit for hours. As my instructor would not appreciate me sitting on my ass for those hours, I moved on and picked another patient. I spent the requisite time recording all the patient's medications, abnormal labs, history, course of illness, etc into what we call a client database. It's a way of pulling information together in order to be ready to provide nursing care. Driving home, I was disappointed that I wasn't able to take Mr. B.

This morning I arrived to find that my patient had pulled his IV out of his hand the night before, refusing to allow a new one to be started, and was generally hostile to staff. Hmmm, maybe an opening here. I asked about Mr. B and found out that he hadn't gone down to surgery yet. I approached my instructor about switching patients and she was a little apprehensive in that I hadn't prepped to take care of him. In an effort to convince her, I quickly read through his chart, copied down his meds (most of which I knew), and made a case that Mr. B was a much better learning experience. I think it was probably my ebullience that won her over.

I quickly did a general assessment (listen to heart and lungs, take vitals, assess neuro status, etc.) right before transport came to take Mr. B down to surgery, with me in tow. We arrived in pre-op and the nurse started the pre-op questionnaire. When asked about allergies, Mr. B said he was allergic to some __________ drug he was on. The nurse went to answer the phone and I thought, "But he's not on a __________ med. I wonder if he means __________?" So I asked him and he said, "Yes, that's it." Then I did a little teaching about what that medication was used for and confirmed the reaction he experienced. When the nurse came back, I was able to show her in the chart where his negative reaction had been documented earlier. Whoo-hoo, mental hi-five.

There was still some question as to whether I could observe the actual surgery. The patient couldn't take food and drink orally, so the surgeon would place a tube through his abdomen into his stomach to allow for what's called enteral tube feeding. Then liquid nutrition could be regularly pushed through the tube using a syringe. The operating room circulating nurse came by and said I could observe. I put on a cap and mask and off we went to the operating room. The scrub nurse was already laying out the various clamps, cloths, retractors, needle and thread, etc. that would be needed. The anesthesiologist and nurse anesthetist started an IV and got the meds going. Within three minutes, Mr. B was under. The circulating nurse asked me if I'd like to insert the Foley. Absolutely (not ironic in the least)!

At this point I'd like to say that I've already seen more than a few lame Rep. Mark Foley/Foley catheter jokes, and will not propagate more. OK then.

I'd put in a Foley once before, so I wasn't too nervous. Plus A) the nurse was walking me through it and B) the patient was unconscious. That done, I stepped back so she could finish prepping him. A few minutes later the surgeon arrived and in less than 30 minutes:
- Sliced down the center of Mr. B's abdomen through the skin and subcutaneous fat
- Cauterized the small blood vessels (it doesn't smell bad at all really)
- Made an incision in Mr. B's stomach and introduced the tube
- Made an exit incision in Mr. B's left abdomen and pulled the tube through
- Stitched and stapled Mr. B closed

Totally routine, but tremendously cool.

They woke up Mr. B and then off we went to Recovery. The recovery room was bustling - lots of surgeries today - and the nurses were busy hooking patients up to EKGs and oxygen saturation monitors, recording their vital signs, and administering pain medication. I pointed out to Mr. B's nurse that he had an IV medication that had been sent along with him that needed to be started. She told me to find the doctor's order in the chart (always necessary). I did and she started the IV thanking me for catching it. Mental hi-five again. Mr. B was doing great and so we disconnected him from monitoring and back we went to his room. Later in the day, I got to deliver his crushed medications and liquid nutrition through the tube.

I'm sure five years from now all this will seem mundane, but today it was awesome.

Sunday, October 15, 2006

Meat Purveyors R.I.P.

They didn't actually die, but Friday night the Meat Purveyors played their last show in Austin. Sigh. Man they are/were so very entertaining.

The night started with Mybloody and I going to End of an Ear so I could exchange some CDs. A store employee (via a scrawled note on a LP sleeve) dared me, so I bought a Juice Newton Japanese import record for $1. Then posed for a photo holding it with a smile that said either "I've been looking for this rare import version with the airbrushed cover forever and now, at long last, I'm holding it!" or "I'm a total douche who buys shit like this just because store employees dare me to." In my defense, it was $1. And her version of "Angel of the Morning" is pure cheezy goodness.

We left and drove over to Joolie's house to pick her up. She showed us some printing she'd been working on. I need a pack of her "Eat a dick" notecards, as do you. Then we headed to Continental Club for the show.

The Weary Boys were meh and we spent most of their set outside talking and going for a slice of pizza down the block. Then Meat Purveyors started and it was glorious. Mybloody had never seen them do their Madonna trilogy ("Lucky Star", "Burnin' Up", and "Like a Virgin" played at breakneck pace) so he was happy when they opened with it. Later they tore through their wonderful version of Ratt's "Round and Round." It's a testament to Ratt's songwriting and the Meat Purveyor's talent that the song sounds so good with twang vocals and mandolin. In between the band energetically zipped through a swath of their own great, punkish, bluegrass originals with at least a few from every album. I really should have gone to see them more often.

We ended the night happy to have seen them one last time and went home to put up our sore feet (mine were from dancing, not from being old).

Saturday, October 07, 2006

My fat scar

Are you lookin' at my gut? I'm workin' on it!

Since a couple people commented on it, I guess I should explain. My scar is rather noticeable and so for years whenever someone asked me about it, I told them about it.

When I was in sixth grade, I sat next to a boy who'd already failed twice. He was much bigger than all the other boys and even had that wispy, teen moustache. I did well in school, he did not. Very soon after the school year started, he let me know that he would be cheating off of me and that I was to let him. If I didn't, or squealed to the teacher, I'd get pounded.

I didn't care for this, so I came up with a plan. For the next multiple choice test I would circle the wrong answers. He'd copy me, then I'd subtly change them to the right answers. I'm sure at the time I thought it was brilliant. Of course, I hadn't thought it through to the logical conclusion. We got our tests back; he got a 0, I got a 100. That afternoon he intercepted me as I walked home from school, pulled out a knife, and slashed me across the stomach.

Except none of that really happened. The kid was real, but he never cheated off me. I just loved telling people that story and seeing their eyes get big.

The real story is more complicated.

When I was ten I started having abdominal pains often. One night it was bad enough that my mom took me to the emergency room. An ultrasound revealed that I had a multitude of small gallstones. Gallstones, deposits of cholesterol or calcium in the gall bladder, are usually a problem in older folks. It's uncommon for kids to have a problem with them. I only had one of the common risk factors: female, fat (obesity), fair (Caucasian), forty (middle-aged), fertile (multiple children).

After various doctors conferred, the recommendation was removal of my gall bladder. It's not a secretory organ itself, it just stores bile produced by the liver. So you really don't need it; the liver will just dump bile directly into the duodenum (first section of the small intestine). The idea was that if I had lots of small ones when I was ten, it was going to be a problem sooner rather than later. I wonder if part of it was also that I was to be the youngest person at the time to have a cholecystectomy - a badge for the doctors.

My roommate at the hospital scared me a little. He'd been accidentally shot in the jaw while hunting which shattered it, and so couldn't speak distinctly. He also drooled a lot. I got to like him after a day though. I imagine some of my distaste for guns came from seeing what happened to him.

The surgery itself wasn't an issue, though I wasn't awake at the time. When the anesthesiologist started the meds, he had me count back from ten. I recall getting to sev...

Recovery was annoying because I couldn't walk well or eat much. I hobbled down the hallways clutching the handrails on the wall; it felt like my thighs was sewn to my chest. I'd get full after a cup of broth. I steadily improved and was happy to go home with a stitched incision. A couple days later I was eating a hamburger (often fatty foods after cholecystectomy cause upset, but I never noticed it) when somebody wanted to see my incision. I pulled up my shirt and everyone saw the small purplish bump on the incision. Not so good.

The sequence of events is hazy, but I ended up back at the hospital being examined by a very concerned doctor. It was an infection for sure. The doctor was worried enough that he started working on it right there in the exam room. No time for anesthesia to take effect so I got the topical cold spray. I was swabbed with some sort of antiseptic and then the doctor popped my stitches.

The next part explains why I have a high pain threshold. The doctor inserted his gloved fingers into the incision and starting pulling out what I recall as pockets of pus. I distinctly remember looking down and seeing his fingers inside me to the knuckle. A nurse - the one who wasn't holding me down - was talking into my ear trying to get me to visualize something more pleasant. She was talking me through getting a good hit in a baseball game. I remember being annoyed because, though I played, imagining a baseball game wasn't all that wonderful for me. But then how was she to know that I'd rather have her talk me through Greek mythology or the plot to The Westing Game?

Now, when I assess patients' pain level ("What would you rate your pain on a scale of 0-10 with 0 being no pain and 10 being the worst pain you can imagine?"), I always remember the intensity of my level 10 pain.

I can't remember much after the fingers-in-the-incision part. I didn't pass out, I just don't recall. The next vivid memory is being in a hospital room with an IV full of antibiotics and the incision packed with gauze. There wasn't room on the infectious unit, so I had been given a room on what I used to call the "terminal kids" ward. Several bald cancer kids and two cystic fibrosis kids were on the same unit. It totally weirded me out when one of the cystic fibrosis kids came to my room and gave me his toys "because I won't need them soon." His mom came by later to get them, apologizing profusely.

I stayed in the hospital for quite a while getting antibiotic therapy and wound care. The wound care consisted of taking off the cover dressing, pulling out the gauze packing (with yellow-green goo), pouring in hydrogen peroxide, gritting my teeth as it foamed up and stung mightily, twitching in pain as silver nitrate sticks were applied to cauterize the wound, then repacking. Twice a day for a long time. Even after I got out of the hospital, my mom picked me up from school to perform the wound care. Because of the infection, I couldn't just be sewn back up again.

So 20 years later I still have a thickened scar running across my abdomen on the right side rather than a thin, white line. Presently, the standard procedure is to perform cholecystectomies laparoscopically eliminating the need to open the belly. Patients now end up with three white dots where the camera and instruments are inserted. Damnit. At least I got a good story out of it.

Friday, October 06, 2006

Emesis assessment

Here's the text of the Powerpoint slide we just went over in class. Fun stuff.

Emesis [also known as vomit] -- Look at it!

- preceded by nausea, precipitating or relieving factors, frequency, is it sudden, projectile, or persistent

-Note color and volume
Clear or greenish vomitus with undigested food-stomach
Bright yellow- bile or upper intestinal
Dark brown with feculent odor- prolonged bowel obstruction
“Coffee-ground” or BRB (bright red blood) - bleeding

The Pumpkin-ing of Yogurt

I just finished a container Lucerne Limited Edition Pumpkin Pie yogurt. As an avid consumer of pumpkin-flavored items (see very first first blog post), I was excited but wary. Turned out to be kinda gross. Oh well. Guess I'll be heading over to 7-11 sometime this weekend to see if they've got the Pumpkin Spice Latte back.

Update: In a pleasant turn of events, the Lucerne Limited Edition Cranberry Orange yogurt is wonderful.

Wednesday, October 04, 2006

Stoopid medical humor

Today in Skills lab we learned how to operate IV pumps. The instructor demonstrated at the front of the lab so we could all see, but since there wasn't a bed and a dummy right there she let the end of the IV hang down into the trash can. Immediately I thought/said, "This trashcan is hypovolemic. Hang a bag of saline before it gets shocky." See, this is what has happened to my sense of humor. Sad really.

Later, the instructor was explaining that it was important when learning how to use unfamiliar equipment to read the manufacturer instructions or watch the training video that is usually available. Relying on co-workers can result in a game of telephone where proper procedure is transmuted into bad habits through a steady accretion of errors or shortcuts. I turned to a friend and before I could even open my mouth he got there first, "Make sure the cartridge lever is pushed down. Purple monkey dishwasher."

Oh Simpsons, is there any situation for which you don't have a relevant quote?

Sunday, October 01, 2006

Anatomical art

Mybloodyself hosted a craft night on Saturday. I'm not particularly crafty, but I do enjoy making shrinky-dinks. Here's a couple:

Shrinky-dink: Myocardial infarction

I just had a test about heart attacks on Friday (96%, whoo!) so it was fresh in my mind. The black part is dead tissue.

Shrinky-dink: The Gall Bladder

This is a salute to an organ I haven't had for more than a couple decades now. The sister of a school friend of mine had to have her's removed this weekend. She'll have three tiny white dots from the laparoscopic surgery while I have a fat 10 cm scar. Ahh medical progress.