Read and unread

Instead of doing something truly productive, I've been catching up on Spacebeer's blog as is obvious from my citing her posts below and adding her to my blogroll. Hi Spacebeer! Why did it take so long for me to read your blog? I've been remiss. Please forgive. Anyway, to placate your ferociousness, here you go:

"someone compiled a list of the top 106 books tagged "unread" on Librarything, and started a nifty little meme.

Here is the plan:
Bold = I've read it for fun [I guess this is a catch-all]
Underline = I read it for school
Italics = I started it but didn't finish
Asterisk = I own it, but haven't read it"

Jonathan Strange & Mr Norrell
Anna Karenina
Crime and Punishment
Catch-22
One Hundred Years of Solitude
Wuthering Heights
The Silmarillion
Life of Pi : a novel
The Name of the Rose
Don Quixote
Moby Dick
Ulysses
Madame Bovary
The Odyssey
Pride and Prejudice
Jane Eyre
The Tale of Two Cities
The Brothers Karamazov
Guns, Germs, and Steel: the fates of human societies
War and Peace
Vanity Fair
The Time Traveler’s Wife
The Iliad
Emma
The Blind Assassin
The Kite Runner
Mrs. Dalloway
Great Expectations
American Gods
A Heartbreaking Work of Staggering Genius
Atlas Shrugged
Reading Lolita in Tehran: a memoir in books
Memoirs of a Geisha
Middlesex
Quicksilver
Wicked: the life and times of the wicked witch of the West
The Canterbury Tales
The Historian: a novel
A Portrait of the Artist as a Young Man
Love in the Time of Cholera
Brave New World
The Fountainhead
Foucault’s Pendulum
Middlemarch
Frankenstein
The Count of Monte Cristo
Dracula
A Clockwork Orange
Anansi Boys
The Once and Future King
The Grapes of Wrath
The Poisonwood Bible
1984
Angels & Demons
The Inferno
The Satanic Verses
Sense and Sensibility
The Picture of Dorian Gray
Mansfield Park
One Flew Over the Cuckoo’s Nest
To the Lighthouse
Tess of the D’Urbervilles
Oliver Twist
Gulliver’s Travels
Les Misérables
The Corrections*
The Amazing Adventures of Kavalier and Clay
The Curious Incident of the Dog in the Night-Time
Dune
The Prince
The Sound and the Fury
Angela’s Ashes: a memoir
The God of Small Things
A People’s History of the United States: 1492-present
Cryptonomicon
Neverwhere
A Confederacy of Dunces
A Short History of Nearly Everything
Dubliners
The Unbearable Lightness of Being
Beloved
Slaughterhouse-five*
The Scarlet Letter
Eats, Shoots & Leaves
The Mists of Avalon
Oryx and Crake: a novel
Collapse: how societies choose to fail or succeed
Cloud Atlas
The Confusion
Lolita*
Persuasion
Northanger Abbey
The Catcher in the Rye
On the Road
The Hunchback of Notre Dame
Freakonomics: a rogue economist explores the hidden side of everything
Zen and the Art of Motorcycle Maintenance: an inquiry into values
The Aeneid
Watership Down
Gravity’s Rainbow
The Hobbit [6th grade reading group - cool teacher]
In Cold Blood: a true account of a multiple murder and its consequences*
White Teeth
Treasure Island
David Copperfield
The Three Musketeers

Man I'm way behind on the classics. Oh well, too many books, too little time.

even patient nurses wound know

Spacebeer finds cool things on the internets. For instance, Wordle. I suspected that somewhere there was a site that created word clouds, but never looked for it assiduously. Here's a cloud of St. Murse blog:



I think I might edit the text a bit and make a T-shirt out of it.

Floating

Last night I worked in another ICU at my hospital for the first time. The surgery schedule has been light with some surgeons on vacation, so my unit has been overstaffed with nurses. It's the way of hospitals, if one unit is overstaffed and another is under, then nurses float to even it out. Technically I'm not supposed to float until I've been off orientation for six months, but my home unit had to keep the experienced nurses to look after the complicated devices (continuous dialysis machines, intra-aortic balloon pumps, ventricular assist devices) which I cannot. Oh well, that's nursing for you.

It was great experience actually. The principle is that floated nurses shouldn't be given a difficult patient load because they're not in their regular environment. Doesn't always happen that way, but it did for me last night. My patients weren't confined to bed, had stable vital signs, and each had only one IV medication running. After assessing them, administering their meds, and performing one dressing change, I didn't have much to do for the rest of the shift aside from charting their vital signs and changing out their IV lines. Then one of my patients who had transfer orders to move to a lower level of care got a room at midnight. After I packed him up and moved him out, I only had one patient for the rest of the shift.

I was able to talk with the other nurses and get a feel for the unit which, though laid out much like the majority of ICUs at the hospital, is very different from my home unit in cardiovascular surgical recovery. With free time on my hands, I read my one patient's H&P (history and progress notes made by doctors) to get a better feel for the situation. Then I moved on to re-reading some hospital policies in an effort to A) know them better and B) stay alert. All in all, it was a nice break from the pace in CV Recovery.

Gross, in a sort of cool way

Squeamish alert! Do not read on if discussion of open wounds gives you the willies.

A nursing classmate of mine told me a wonderfully vile story. The patient she was caring for was a woman whose hysterectomy incision had opened up. I don’t know the specific circumstances of the case, but even well-approximated incisions (the edges coming together nicely) can open up if the stitches or staples burst open due to a forceful cough or errant Valsalva maneuver.

Anyway, that’s just academic. The reality was that the patient was quite obese and the wound was a foot deep. Yep, from the skin all the way down to where her uterus used to be was a solid 12”. Care for such a wound involves cleaning the bed of the wound to minimize the risk of infection and promote healing. It took two people bracing themselves on either side to pull back the sides of the wound enough so that another nurse could get all the way down in there with a sponge.

Wheee! Sometimes nursing is just delicious huh?

Memo to Mr. Misogynist Q. Patient

If, when you ask if I have a sense of humor, you mean laughing when you say, "Now that I've got better blood flow, maybe I can do something with it," while I'm cleaning your catheterized penis, or joining you in denigrating your female relative's job as a way of complimenting mine, then no, I don't have a sense of humor.

Also, refrain from automatically assuming that male staff are doctors. Despite us referring to ourselves as "your nurse," you continually called the day shift nurse and I doctors. The women in the white coat with her name clearly printed on the pocket? She's the surgical resident who scrubbed in on your operation, not as you assumed, the charge nurse.

I am being a little hard on the guy. He was anxious, feeling out of control and his coping mechanism of choice was joking around. It's a much more positive mechanism than regression or somatization. It's why I gave him some slack, kept quiet, and ignored his attempts at humor. And yet, even though he "comes from a different era", you have to know that making sexual comments about the female staff is big fat no-no. By the morning, I was weary of it.

When I leave at the end of my shift, if my patients are awake and likely to be transferred out to a lower level of care that day, I sincerely wish them well. This guy, I just said, "Feel better," without eye contact. Petty, I know, but man he was grating.

Another thing I love is tarnished, though electroplated in hate would be more accurate

While my love of science fiction began in high school, it truly flowered in college thanks to books loaned and recommended to me by a couple of friends (thanks M & E). Many college bullshitting sessions were spent discussing the implications and questions arising from the works of Le Guin, Varley, Brin, etc. Above them all though, was Orson Scott Card. How we adored him. He's descended into almost total suckage over the last decade or so, but still, Ender's Game, Speaker for the Dead, The Worthing Saga? Masterful.

Well, now he's done it. Sure I always knew he was a devout, Elder-kiss-up Mormon, but now he's calling for violent revolution against the U.S. government if gay marriage becomes common. No need for me to rant on as Michael Swaim (who knew Cracked.com had such astute writers?) has laid out the arguments beautifully. Warms the heart really.

Unlike Swaim and others I've seen, I'm not tossing the Card books I treasure. I won't buy another copy new, but good stories are good stories even if they're told by a greedy, bigoted asshole who I nonetheless will endeavor to consider a person deserving of love. And I don't even claim to be a Christian.

Where to start with the wonderfulness of Tom Giesler's anatomical chart art? Hilarious and gorgeous.

Attention to detail: How to avoid dumb questions

A few weeks ago at work the patient care techs were busy and my patients were tucked away so I answered a spate of phone calls to the unit. One call was from the lab, "Patient X? The sample in the green top [test tube of blood] is hemolyzed [red blood cells are ruptured]. We need another one sent."

I walked down the hall to convey the message to the patient's nurse, "Lab called. That sample's hemolyzed. Can you send another one?"

"Well no," she said, looking at me curiously, "The patient's dead."

I looked over at the bed and monitor for the first time. Sure enough.

A little medication-based nursing humor. Very little.

This week I was talking with a couple of women at work and the conversation turned to diets and losing weight. We’re all nurses so we know about the physiological processes involved and how some diets (i.e. Atkins, South Beach) initially show quick response because they result in mostly water loss.

That reminded one nurse of the time she found Lasix among her deceased grandmother’s things. Lasix prevents the kidneys from reabsorbing sodium and where sodium goes, so goes water due to osmosis and all that. No sodium reabsorption means peeing out a lot of fluid. Water weighs 2.2 pounds per liter (or the metrically more sensible 1 L = 1 kg), so that can add up to tidy weight loss. Along with all that water, important electrolytes are also peed out, particularly potassium, a dearth of which can cause life-threatening heart arrhythmias.

With all that in mind (I know, it’s a lot to keep in mind), the nurse explained her logic thusly,

“I found Lasix pills in my grandmother’s medicine cabinet and I was thinking about fitting into pants better, but I had no way to monitor my potassium levels and I don’t like bananas so…”

“Aside from the ethical implications of a health professional taking medications not prescribed for her,” I responded, ”You could have just eaten avocadoes.”

“Avocadoes?!” she exclaimed, “The whole point was to make my butt smaller.”

“Yeah St. Murse,” the other nurse said, “Duh.”

I love my co-workers.

Take every 6 hrs as needed for indifference

Every couple of months the class of new nurses with whom I started meets for continuing education. The day’s agenda always includes time to talk about the challenges of the job. Essentially it’s a good-natured bitch session. Last time we met, someone brought up calling residents for orders and getting a less-than-confident or lackadaisical answer. Residents are still training as doctors and don’t know everything so nurses often coach them along. A common response from the docs is, “What do you usually do?” or “What do you want to do?”

I prefer the first question because it falls back on the routines of the attending physicians. They’re usually asking because hospitals differ in their preferences, not because they are clueless. At Hospital A, the typical orders for nausea are medication X at such-and-such dose and timing, while at Hospital B it’s medication Z. The second question, “What do you want to do?” is more annoying to me, because, you know, they’re the doctor with prescriptive authority. It’s putting the onus on the nurse with the doctor just agreeing or not with the suggestion. The worst though is when they obviously aren’t engaged. As one fellow nurse dramatized it:

Nurse: Doctor, Mr. Smith is getting increasingly hypertensive.

Doc: Uhh. Hydralazine 10 mg, or whatever. I don’t care.

In class I wistfully offered how great it would be if we could write out the order and fax it to the pharmacy just like that.

8/23/08 1935 Hydralazine 10 mg, or whatever. I don’t care.
TORB (telephone order read back) Dr. Apathy/St. Murse, RN

Found: paranoid chart

I found this taped to a bus stop. "Beware LADIES HE Will Come and SEX you at Night" and by HE, the author means SATAN.



My favorite part is "Stupid Idiot Daft Punk." Sure they might be harder, better, faster, and stronger, but apparently they are also stupider, idiotic, and somehow involved with Satan.

Obese begets obesesier

In an August 9th New York Times op-ed piece, Olivia Judson writes about rat studies which show that mothers who consume large amounts of junk food (as opposed to balanced rat chow) while pregnant give birth to babies with a hankering for junk food. Human studies are less definite but,

"...the results of several studies suggest that the very fact of a woman being obese during pregnancy may predispose her children to obesity. For example, one study found that children born to women who have lost weight after radical anti-obesity surgery are less likely to be obese than siblings born before their mother lost weight. Another study looked at women who gained weight between pregnancies; the results showed that babies born after their mothers put on weight tended to be heavier at birth than siblings born beforehand. Since the mother’s genes haven’t changed, the “fat” environment seems likely to be responsible for the effect."

Speaking as a health care professional who routinely cares for obese people, uh, yikes. This could result in a nasty geometric progression of obesity and related disease (diabetes, hypertension, heart and vascular disease, stroke, cancer, sleep apnea) in the next generation. Not to mention the increased incidence of lower back problems in the nurses who have to move such patients. Body mechanics of moving patients was one of the first things I learned in nursing school skills class and rightly so.

Heart, in wire

I commissioned this sculpture from a talented artist, CW Roelle. I like it.