So what do you think of mandatory swine flu shots for nurses?
Wednesday, October 14, 2009
Monday, July 27, 2009
Skill
Last week I worked my last couple of shifts. During that time, I discovered what makes a good nurse, according to my patients anyway.
Surprisingly, it wasn't compassion, knowledge, or skill that they commented on.
It was my ability to kill flies with washcloths.
Monday, July 6, 2009
Punctuation? Who needs punctuation?
A blurp from the nurse's notes: (not mine)
"Will continue to monitor wife in the room."
Laughter is a good stress reliever for a crazy job.
"Will continue to monitor wife in the room."
Laughter is a good stress reliever for a crazy job.
Saturday, June 27, 2009
The Little Red Henship
This makes me happy:
Jale buys 3 kilos of wheat in the market several times a month. She
carries it home in her basket, then spreads out the kernels on our
cookie sheets. She picks out the bugs, the rogue grains of corn and
rice, and then carefully washes the wheat before spreading it out
again to dry.
The next day, after a good dose of anti-mould sunshine, the wheat is
carried in Jale’s basket to the mill. She pays 1 birr (10 cents US) to
have it ground into whole wheat flour, which comes back in the basket
and is sealed into a Rubbermaid tub in our cupboard.
My part in this little red henship is small. I just make the bread,
with yeast from Saudi Arabia and iodized salt from Egypt.
We are so spoiled, eating that bread smothered in avocado and garlic
salt, or with Kenyan peanut butter and homemade mango jam.
This makes me happy:
Jale buys 3 kilos of wheat in the market several times a month. She
carries it home in her basket, then spreads out the kernels on our
cookie sheets. She picks out the bugs, the rogue grains of corn and
rice, and then carefully washes the wheat before spreading it out
again to dry.
The next day, after a good dose of anti-mould sunshine, the wheat is
carried in Jale’s basket to the mill. She pays 1 birr (10 cents US) to
have it ground into whole wheat flour, which comes back in the basket
and is sealed into a Rubbermaid tub in our cupboard.
My part in this little red henship is small. I just make the bread,
with yeast from Saudi Arabia and iodized salt from Egypt.
We are so spoiled, eating that bread smothered in avocado and garlic
salt, or with Kenyan peanut butter and homemade mango jam.
Nightfall
I got called in the other night at about 11:00pm to pronounce one of
our pediatric patients. She was a twelve year old, severely
malnourished girl, with failing liver and kidneys and severe anemia.
The nurses do not like to be the ones to record a death. They don’t
like the end of life care, and they don’t like dealing with the
financial problems once a patient has passed on.
I don’t either. And I’m not really qualified for the job. But I know
it is difficult for the nurses and I’m glad to come in and support
them.
By the time I arrived the child had not been breathing for over ten
minutes. When I put my stethoscope to her chest, I could only hear the
faintest whisper of her heart, trembling.
As I looked at her frail, exhausted body, jutting bones sticking out
everywhere, I knew it would only be cruel to start CPR. The physicians
had been in to see her, they had done what they could.
Abezash and I took out her IV and the naso gastric tube, and we let
her mother hold her one last time, all quiet and still in our freshly
painted pediatric ward.
I signed the papers with the business office, wrote in the chart, and
talked with the nurses for a while in the glare of the florescent
lights in the nurses’ station.
And then, dim and tired, I walked down the slick muddy path to our house.
I got called in the other night at about 11:00pm to pronounce one of
our pediatric patients. She was a twelve year old, severely
malnourished girl, with failing liver and kidneys and severe anemia.
The nurses do not like to be the ones to record a death. They don’t
like the end of life care, and they don’t like dealing with the
financial problems once a patient has passed on.
I don’t either. And I’m not really qualified for the job. But I know
it is difficult for the nurses and I’m glad to come in and support
them.
By the time I arrived the child had not been breathing for over ten
minutes. When I put my stethoscope to her chest, I could only hear the
faintest whisper of her heart, trembling.
As I looked at her frail, exhausted body, jutting bones sticking out
everywhere, I knew it would only be cruel to start CPR. The physicians
had been in to see her, they had done what they could.
Abezash and I took out her IV and the naso gastric tube, and we let
her mother hold her one last time, all quiet and still in our freshly
painted pediatric ward.
I signed the papers with the business office, wrote in the chart, and
talked with the nurses for a while in the glare of the florescent
lights in the nurses’ station.
And then, dim and tired, I walked down the slick muddy path to our house.
How to Get a Driver’s License
To get a driver’s license in Ethiopia, an American must first go to
the American Embassy. It takes you thirty minutes to pass through an
exhaustive security process, and then you sit for an hour in a cramped
waiting room, watching for your number to flash red on the screen.
The embassy charges you $30, (a small fortune by our volunteer
budgets), for a document that states your Maryland driver’s license is
valid. You raise your right hand and swear to be giving true
information, and then exit through another extensive security
screening out into the bright sunshine.
(While sitting in the waiting room I was surprised to see two equally
large framed photographs on the wall, one of Hilary Clinton and one of
Barak Obama. I thought to myself—“Did they not get the memo regarding
who won the elections?” But as I squinted I read beneath Hilary’s name
“Secretary of State.” And then it made more sense. News travels to
this corner of the world very slowly).
Your next stop is the Ethiopian Bureau of Foreign Affairs. You need
them to give you a document that says your document from the American
Embassy is valid.
Silly, I know.
So you sit for another hour, this time on an uneven cement porch with
a rusty tin roof, waiting for someone to call your name with barely
recognizable vowel sounds. You pay another $30, for another piece of
paper with stamps and signatures and a lot of scribbly Amharic.
But you still don’t have a license. It’s 11:00 am, and the Bureau of
Transportation will be closed for lunch until 2:00 pm. (What
government offices have a three hour lunch break? That’s what I would
like to know. I want to work there.)
You walk back to home base—the Adventist Union offices--and eat a hot
vegetarian lunch in a noisy cafeteria filled with suited business men.
You are the only woman present.
You are also the only woman applying for a driver’s license today, as
you find your place in line at the three-storied Transportation Bureau
office. It’s hot and smelly in that line. A tall dark-eyed man from
Egypt jostles in front of you, impatiently shoving his papers under
the plastic window.
You have your papers, your actual American driver’s license, four
passport photos, your actual passport, a copy of your visa, a copy of
your driver’s license, and enough money to cover the new license, the
lamination, the postage stamp that they laminate on the back, and the
“officer’s fees.”
They don’t care that you haven’t driven a vehicle in 10 months, they
don’t care how many tickets you’ve received in your home country (for
the record: none), they don’t care whether you can drive at all; as
long as you have the appropriate stamps and copies and signatures and
expensive papers in your hand, you’re good to go.
Just a few minutes more, now. Your patience will pay off.
To get a driver’s license in Ethiopia, an American must first go to
the American Embassy. It takes you thirty minutes to pass through an
exhaustive security process, and then you sit for an hour in a cramped
waiting room, watching for your number to flash red on the screen.
The embassy charges you $30, (a small fortune by our volunteer
budgets), for a document that states your Maryland driver’s license is
valid. You raise your right hand and swear to be giving true
information, and then exit through another extensive security
screening out into the bright sunshine.
(While sitting in the waiting room I was surprised to see two equally
large framed photographs on the wall, one of Hilary Clinton and one of
Barak Obama. I thought to myself—“Did they not get the memo regarding
who won the elections?” But as I squinted I read beneath Hilary’s name
“Secretary of State.” And then it made more sense. News travels to
this corner of the world very slowly).
Your next stop is the Ethiopian Bureau of Foreign Affairs. You need
them to give you a document that says your document from the American
Embassy is valid.
Silly, I know.
So you sit for another hour, this time on an uneven cement porch with
a rusty tin roof, waiting for someone to call your name with barely
recognizable vowel sounds. You pay another $30, for another piece of
paper with stamps and signatures and a lot of scribbly Amharic.
But you still don’t have a license. It’s 11:00 am, and the Bureau of
Transportation will be closed for lunch until 2:00 pm. (What
government offices have a three hour lunch break? That’s what I would
like to know. I want to work there.)
You walk back to home base—the Adventist Union offices--and eat a hot
vegetarian lunch in a noisy cafeteria filled with suited business men.
You are the only woman present.
You are also the only woman applying for a driver’s license today, as
you find your place in line at the three-storied Transportation Bureau
office. It’s hot and smelly in that line. A tall dark-eyed man from
Egypt jostles in front of you, impatiently shoving his papers under
the plastic window.
You have your papers, your actual American driver’s license, four
passport photos, your actual passport, a copy of your visa, a copy of
your driver’s license, and enough money to cover the new license, the
lamination, the postage stamp that they laminate on the back, and the
“officer’s fees.”
They don’t care that you haven’t driven a vehicle in 10 months, they
don’t care how many tickets you’ve received in your home country (for
the record: none), they don’t care whether you can drive at all; as
long as you have the appropriate stamps and copies and signatures and
expensive papers in your hand, you’re good to go.
Just a few minutes more, now. Your patience will pay off.
Tuesday, June 23, 2009
A Nursing Conspiracy
Sometimes I wonder if the patients ever get an idea of what nurses do "behind the scenes". Those times when they seem to be sitting idly behind the desk just talking on the phone. It makes me think of one patient who probably would have panicked if he had known about "the conspiracy".
Shift started routinely enough with report. A middle aged patient who'd come in during the night for chest pain. He'd continued to have chest pain but no ECG changes. "Sounds like another one for the cath lab," I said, while scribbling absent-mindedly on my notes.
"Yes, but the doctor hasn't come around to write any orders yet," the night nurse answered.
"Okay, we'll just wait and see," I mumbled while pulling up the morning labs.
Suddenly, I realized that I was staring at the highest troponin level I'd ever seen. Okay, so maybe it was time to call the doctor and not wait for him to show up. Quickly I paged the doctor and went to see how the patient was doing.
The patient was doing as well as anyone with severe pain could be, although he felt a bit short of breath. Over the next 45 minutes his pain became worse except for short respites after the morphine and nitroglycerin where given.
Still no response from the doctor, so I called again. After another period without response I called the answering service who tried to contact his cellphone. When this was unsuccessful I came upon the idea for "the conspiracy".
This doctor often goes to the cath lab before seeing his patients. What if this patient were prepped and laying on the cath lab table when the doctor arrived? He could write the order on arrival, or he would be so mad that he would call me and I could tell him what I thought about paging him for 3 hours without response.
Immediately I called the cath lab and explained the situation to the nurse: elevated troponin, severe chest pain, and no orders. "If I prep him and place the unsigned orders on the chart, will you come and get him?" I pleaded.
With only slight hesitation, she agreed, and we soon had the patient prepped and off to the cath lab. Hours later I had not heard anything about the patient. No angry phone calls from the doctor, but no sign of the patient either. Nervously I called around from unit to unit, finally, "Oh, Mr. _______ he's being prepped for emergency bypass surgery right now."
A few days later when the patient was back to our unit recovering I peeked in his chart. I just had to see his doctor's signature on the cath orders. There they were, and just below them, the signature of my co-conspirator.
Shift started routinely enough with report. A middle aged patient who'd come in during the night for chest pain. He'd continued to have chest pain but no ECG changes. "Sounds like another one for the cath lab," I said, while scribbling absent-mindedly on my notes.
"Yes, but the doctor hasn't come around to write any orders yet," the night nurse answered.
"Okay, we'll just wait and see," I mumbled while pulling up the morning labs.
Suddenly, I realized that I was staring at the highest troponin level I'd ever seen. Okay, so maybe it was time to call the doctor and not wait for him to show up. Quickly I paged the doctor and went to see how the patient was doing.
The patient was doing as well as anyone with severe pain could be, although he felt a bit short of breath. Over the next 45 minutes his pain became worse except for short respites after the morphine and nitroglycerin where given.
Still no response from the doctor, so I called again. After another period without response I called the answering service who tried to contact his cellphone. When this was unsuccessful I came upon the idea for "the conspiracy".
This doctor often goes to the cath lab before seeing his patients. What if this patient were prepped and laying on the cath lab table when the doctor arrived? He could write the order on arrival, or he would be so mad that he would call me and I could tell him what I thought about paging him for 3 hours without response.
Immediately I called the cath lab and explained the situation to the nurse: elevated troponin, severe chest pain, and no orders. "If I prep him and place the unsigned orders on the chart, will you come and get him?" I pleaded.
With only slight hesitation, she agreed, and we soon had the patient prepped and off to the cath lab. Hours later I had not heard anything about the patient. No angry phone calls from the doctor, but no sign of the patient either. Nervously I called around from unit to unit, finally, "Oh, Mr. _______ he's being prepped for emergency bypass surgery right now."
A few days later when the patient was back to our unit recovering I peeked in his chart. I just had to see his doctor's signature on the cath orders. There they were, and just below them, the signature of my co-conspirator.
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