Thursday, November 20, 2008

The Rhythm Method

This is a meme so sweetly hoisted upon me by Betty.  I was supposed to go to my pictures and pick the sixth picture out of the sixth folder.  Since my pictures aren't filed that way on my computer, I decided to pick the 6th picture from the sixth month.  When I'm all done telling you the story of this photo, I'm supposed to pick 5 people to tag.  I hope I know 5 people.

In the early 90s, I worked on a complex nursing unit that was so heavy that instead of calling it by its designated name, 3 East, we called it 3 Beast.  I was an ACM-assistant clinical manager, otherwise known as a fool because I took that position for the measly extra dollar an hour.  In addition to being in charge 5 days a week, I took a full patient load.  We had vasculopaths, renal failure, telemetry, respiratory failure and fresh transplant patients.  Talk about your nightmare of a unit, this was it.  

We had one physician, Dr. Anal Retentive, who hated the emergency room so he routinely had the sickest of his patients directly admitted to our unit. In this manner, we could hone and utilize emergency room skills without the benefit of emergency room staff and equipment.  He was a kidney specialist and it wasn't unusual for those patients to arrive with potassium levels so high, they were nearly incompatible with life.  To complete the picture, because of Dr. Anal's silly phobias, it wasn't unusual to have more than one crash cart opened at a time-in different rooms.  Somethings gotta give when a patient's potassium level is greater than 7.  If that's the case, it'll be the heart that cries uncle.  Simultaneous codes are always welcome on units such as this.  This too helps hone those ER skills.

One evening, I needed to start a nitroglycerine drip on a patient in  hypertensive crisis.  He had no IV and no prospects for starting one.  In short, he had no veins.  This should have been the first warning bell to go off.  I called the resident to put in a central venous catheter.  He came with his senior resident in order to show this resident his do one.  That's how they learn you know: see one, do one, teach one.   Between the two of them, they were going to insert a central line in this patient who had no veins.  They tried once and bent the guide wire.  They tried again.  When they asked me to do an arterial blood gas on the blood that was squirting from his neck like a geyser, I knew something was amiss.  Remember, he was hypertensive.  Of course it would squirt like Old Faithful, but these two docs needed a blood gas to be sure.  Sure enough, this was not venous blood, it was arterial and no good for an IV.  They tried a third time using the groin.  This time, they'd hit the vein but because the patient  was a vasculopath, they couldn't advance the catheter.  His blood vessels were a twisted nightmare that refused to stay close to anatomical landmarks.  They had me call the senior's senior.  Now there were 3 residents in there and with a Hail Mary, it was one more time for good luck.  Like in the previous attempts, they used the neck and eureka!  They hit an artery.  Again.  This was turning into a nightmare for my patient, for me and for those doctors.  I felt bad for the patient, but a lifetime of IV drug abuse can lead to bad outcomes-LIKE NO VEINS.  The docs were fatigued and left the last one (in the artery) in so they could take a break.  Two hours later, they came back refreshed, pulled the arterial central line and on their fifth try, finally nailed it (I bet they went and read a textbook).  I'd  spent a total of 5 hours of my 8 hour shift secluded in that patient's room while the rest of my patients took care of themselves.

A week later, I found this Far Side cartoon on T-shirts at the mall.  I bought one for each of those docs and never let them live down that night from hell.  I still see one of those docs on occasion and he tells me he still has his shirt.  Ahhh, I have such fond memories of that unit.  Not.

I  liked the idea behind this meme.  I can't pick just five, so if you're reading this, I pick all of you. I'll know if you read this so consider yourself tagged.  You're excused if you've already done this meme or object to memes on religious grounds.  In that case, I'll need a note from your spiritual care provider excusing you. I'll  be expecting a good story to go with your sixth of six.

In the event you're counting, I'm 20 down with 10 to go for my daily blog post insanity.  On the first day of December, I shall rest.  I'm almost out of ideas but with Mr. Larger Than Life coming for dinner on Thanksgiving, I should be able to stock up on stories. Thanks Betty for helping me come up with today's post.


flydragon said...

Since I am also a Swami along with quite a few other things that I will not mention, I am excusing myself from this meme for religious reasons.

Brenda said...

Rudee I think you should look into publishing some of your writing. Seriously!!!! I think you would be very good at it. Well, you are already good at it, it is just weather you want to get anything published. This story made me tired just thinking of that day for all of you involved. The t-shirts were perfect and it was neat that you ran into the Dr. that said he still has his shirt. Have a great day!

Rudee said...

Very original flydragon.

Wow Brenda. Thank you. I was so envious once when i read a reader's digest article that was more or less a day in the life of a nurse. I laughed but felt more like crying because it was so true. That's the only time I looked at something and thought, I could have written that from a shared experience viewpoint.

Gill - That British Woman said...

I was scrunching my face all the way through that post.......I bet that hurt, the groin thing got to me!!

I am talking about pap smears tomorrow, there's a funny story among it all which should interest you!!

Gill in Canada

Rositta said...

I just had a day from hell, early morning pap smear, high blood pressure and an Italian funeral. I just check the 6th picture from the 6th folder and it made me feel better. I may post it...ciao

Rudee said...

Wow Rositta, your dance card was full. What an intriguing schedule you had.

I don't know Gill, you should read what Brenda can do with paper exam gowns. That still makes me laugh. I'll check tomorrow to see if you top her.

WT said...

I've been in the same situation, except I was the guy on the gurney. Nitro drip, no veins.