smalltimore

Of Baltimore's many monikers (including Charm City, The Greatest City in America (seriously--it says so on the public benches), The City That Reads, The City That Bleeds, and Mob Town), my personal favorite and most used is Smalltimore. One, because it just sounds silly, and two, because it's true. Don't let the big city trappings fool you--if you spend even just 24 hours here you WILL run into someone you know. Case in point: My friend who came to visit this weekend got hit on by a dude in a bar. We went to brunch the next morning on the opposite side of town. Dude was our waiter.

After spending such a long time in New York City, I find this aspect rather comforting. It makes me feel like I'm a part of something, and it's forcing me to deal with my social anxiety--the "look at your cell phone and pretend not to notice" trick doesn't work as well when you're the only two people on the sidewalk. And you're more accountable to how you treat people. Not that I was ever a total jerkface or anything, but it's making me think hard about my moments of inconsideration. No longer can I just ignore the texts of someone I've been on a few dates with and say to myself, "Oh well, it's not like I'll ever run into him again." (Which doesn't mean I won't still ignore the texts, just that I can't say that...IT IS A WORK IN PROGRESS HERE, PEOPLE.)

A new element of the smallness I hadn't considered until recently is the likelihood of running into patients. Unfortunately, ICU patients are less likely to be seen out and about than those from other areas of the healthcare continuum, but their family members aren't. Two weeks ago I saw the daughter of patient I took care of for three days crossing my street. This morning I noticed the son of another one at the farmers market. And then I noticed the wife. And then I noticed...the patient! I was more than a little bit surprised. Three weeks ago, I suctioned bloody sputum out of his lungs and stood by as a newly minted MD performed her first paracentesis (i.e., draining the "beer" out of a beer belly). And here he was, all cleaned up and inspecting peaches with his family on a sunny summer morning. There was a tear or two beneath my sunglasses. And then I felt kind of creepy.

from the "poignantly sad moments in nursing" files

I arrive to work and one of my two assigned patients is already in a body bag. We spend the morning taking care of the living one and waiting for Transport to take the dead one to the morgue and for Housekeeping to clean the room. I look in and notice an "About Me" poster on the bulletin board. I make a mental note to make sure it's gone before the next patient arrives. (Housekeeping sometimes forgets about the bulletin board, and having cards and things from a prior patient in the room is, obviously, not ideal.)

Sometime in the late afternoon (this transport and cleaning business takes forever), the new patient arrives. We do all the new patient things--vital signs, EKG, swabs in various orifices for various cultures, etc. I open the garbage can to throw away the used blood glucose finger stick supplies. At the bottom lies the "About Me" poster. "My name is John," it says. "My pet is Lucy--Chow-Chow mix. I like astronomy, running, and classical music."

Next!

Fuck.

from the "wildly inappropriate moments in nursing" files

Two nurses and I are bathing a patient--a 23-year-old girl with acute liver failure due to drinking a pint of vodka a day since age 15. She is in bed, yellow as a Simpsons character, and on the wrong end of the coma scale. I am holding her up on her side so that Nurse 1 can scrub her back. Nurse 2 is emptying her rectal tube drainage bag into a measuring container.

Nurse 2: I kind of want to go to Nearby Pub tonight. You working tomorrow?
Nurse 1: Yeeeeah. Sorry.
Nurse 2: Just for a little bit?
Nurse 1: Ok, sure. I guess a drink won't kill me.

Eye contact is made. Jaws drop. I turn my face away from the patient because I am trying to suppress that particular kind of laughter that comes on in awkward situations and it is not working. We go about the remainder of the bath in silence.

speaking of nursing having its own language...

In the hospital, there is no time for actual, you know, words. As a result, medical professionals have come up with various acronyms, abbreviations, and mnemonic devices to document patient data and aid with assessments. Some of them have more than one (very different) meaning, and many of them make no sense to anyone not high on marijuana (or whatever the kids are getting high on these days...someone in the pediatric ICU let me know?). Here are some of my favorites, so far, in vaguely alphabetical order:

B-52 (or, how to knock out a belligerent psych patient) - Benadryl, 5 mg of Haldol, 2 mg of Ativan
BM - black male, bone marrow, bowel movement
BRBPR - bright red blood per rectum
BRP - bathroom privileges
BURPS - building and understanding roots, prefixes, and suffixes
CABG (pronounced "cabbage") - coronary artery bypass graft
DIAPERS (when assessing for urinary incontinence in the "older adult") - delirium, infection, atrophic urethritis, pharmaceuticals, excess excretion, restricted mobility, stool impaction
ED - eating disorder, emergency department, erectile dysfunction
FFF - fat, female, forty (the most common gallstones demographic)
The Six F's of Abdominal Distention: fat, fluid, flatus, fetus, feces, fibroid (such a ring to it, no?)
DNKA - did not keep appointment
NKDA - no known drug allergies
GSW - gunshot wound
DSW - discount shoe store
(just kidding)
CVA - cerebrovascular accident (woopsies!)
I GET SMASHED (when assessing for pancreatitis) - idiopathic, gallstones, ethanol (booze), trauma, steroids, mumps, autoimmune, scorpion sting (WTF), hypercalcaemia, hypertriglyceridaemia, hypothermia, ERCP (endoscopic retrograde cholangiopancreatography), drugs (e.g., azathioprine, diuretics)
LLL - left lower lobe (of the lung)
RRR - regular rate and rhythm (of the heart)
mg - miligram
Mg - magnesium
MG - myasthenia gravis
MVA - motor vehicle accident
MVP - mitral valve prolapse
OLDCARTS (when assessing anyone complaining of anything) - onset, location, duration, characteristics, associated symptoms, radiation, treatments, summary
PE - physical examination, pulmonary embolism
PROM - passive range of motion, premature rupture of membranes
PUPPP - pruritic urticarial papules and plaques of pregnancy (in other words, an itchy rash)
SOB - shortness of breath
TLC - tender loving care, total lung capacity (RIP, Lisa "Left Eye" Lopes)