Wednesday, September 25, 2013


[This weekend I visited friends in NY and discussed my blog with one of them and how I hadn't posted anything in ages but I had a bunch of like 3/4-written posts, and he was like "they're probably good!" and I was like "meh." On the off chance he's right, here is a post I wrote a couple weeks ago but didn't actually post, lamenting how I hadn't posted anything in a long time. Enjoy!]

Oh jeez. I haven't posted in four months. And my last post was about how I hadn't posted in a long time. And how maybe I'd go back and finish posts I'd started in the, like, four months prior to that. Well, I didn't finish any of those. And now I have a whole nother collection of partially done posts that I also probably won't finish.

Here's some work-related stuff, both current and from four months ago.

One important role of The Nurse is patient education--about their meds, their treatment plan, their illness, their dietary choices OMG please don't take three desserts and two sweetened iced teas with your dinner now I am totally going to have to page the doctor when we check your blood sugar at bedtime and then check it again at midnight. Anyway, the other night, about four months ago, I was in the Med Room getting my patient's nighttime meds ready, and, as I usually do when I give out meds other than like Tylenol and Maalox, I assess to see whether the patient knows what medication he or she is taking and what it is for.

Me: Can you tell me what you take at night?
Patient: Zyprexa.
Me: Yep! And can you tell me what the Zyprexa's for?
Patient: Yeah, it's for racism.
Me: Oh, um. Actually. Soooo it's to help clear your thoughts.
Patient: No, it's for racism.
Me: Okay. Would you like water or orange juice with that?

In my charting of this teaching, I put "requires reinforcement" in the Comprehension category.

In every patient's History and Physical and admission documentation is their Chief Complaint. This is, essentially, the reason the patient came into the hospital. It may not necessarily be what is actually wrong with the patient. So we try to use direct quotes, rather than make assumptions. So, like, if I go to the ER, and I say, "It burns when I pee," my Chief Complaint would be "It burns when I pee" and not "urinary tract infection." Because maybe I could have chlamydia instead, or a recent unfortunate encounter with a jalapeno, or something. Anyway, and this is probably anticlimactic now that I've been rambling, but the best Chief Complaint I have seen in some time is:

. . .

"I am having psychiatric thoughts."

. . .


Some quotes from the psych Emergency Department chart I read the other day (four months ago):

"Patient is urinating on the floor, in Room D."

"Patient was admitted to Other Psych Unit in 1997 for increased energy and fear that her kittens were sabertooth tigers."

"Patient needs admission for behavior incompatible with living in society."


The other day (like, within the last few weeks) I, with only the most serious intentions, attempted to find the scientific term for "booger" on Google. A very disorganized schizophrenic patient had had a large booger hanging out of her nose, you see, and seemed to be unaware of this. So I handed her a tissue, told her she had a booger hanging out of her nose, and asked her to wipe her nose with the tissue. She did (after first attempting to wipe her nose with the blanket she had draped over her head like a nun's habit). And then she threw the booger-y tissue at our unit clerk. I reprimanded, er, provided redirection to, the patient, and told her that tissues go in the garbage. "I thought she WAS the garbage!" the patient replied.

So anyway, I wanted to document this incident in the patient's Behavior Description note. But it felt weird to write "booger" in there--an electronic document that could potentially be read by other nurses and physicians and (long shot) legal people. But it turns out there is no scientific term for booger. The closest I could find is rhinolith, which is a calcium deposit in the nose and decidedly NOT a booger, and "dried nasal mucus," which is just lazy and not entirely descriptive. So "booger" it was.

I've written before how occasionally I have these moments when I catch myself looking at someone eating (usually alone) and feel a wave of profound sadness. I guess it's the sudden reminder that we're all really just these tiny organisms on a relatively tiny planet, subconsciously, automatically, just trying to keep ourselves alive. I could've had the same thought had I been floating above myself tonight, watching myself eat my home-cooked meal for one of seared polenta topped with tomato-portabello-olive sauce. Anyway, shit got even more profound the other night (a couple months ago) when I heard in Evening Report that Booger Patient had a new delusion that her father and two members of the clergy were coming to the unit to have dinner with her. And that she had prepared dinner trays for each of them, and set them on a table in the back hallway, on the other end of the unit from the dining area. Trays complete with an entree, a piece of fruit, a beverage or two, and a cup of ice.

No one was coming to visit her for dinner. These trays remained in the back hallway until night shift started (11pm) at which point I dumped the contents into the trash and stacked the trays on the kitchen counter for Nutrition to pick up in the morning.

Here is Isabella Rossellini "exploring the mating habits of snails." And other small creatures, if you poke around the Green Porno website (no pun intended), which I highly recommend.