best med rec this week by far

Medication reconciliation done on a 14-weeker prego who came in with shortness of breath:

1. Methadone

"I can tell you all about it--dose, how long I've been taking it, where I go to get it..."

"Are you taking prenatal vitamins?"

2. Oh yeah, I'm taking those

3. I have an inhaler, but I lost it.



"Do you have an ob/gyn?"

"Yeah."

"Who is it?"

"I can't remember the name."

Father: "Do you mind if I go out? I left my kid in the car."

It's 3 a.m., and they just made runner-up for the Parents Of The Year award. Almost tied with the parents of the 6-week-old who fell off the bed because "he rolled a little." Send more nominations to me. The contest is ongoing.

undercrowded

Ever since we moved to this house I have had trouble sleeping. It seems like I can't get through a night without waking up.

My first thought was that it was because I was working more night shifts. Bigger mortgage=have to work more=more stress=insomnia.

But I think that I have discovered the root of the problem. The bedroom is just TOO BIG. While it is lovely--with 2 closets, a fireplace, a bathroom, and a balcony facing the backyard--I do not feel secure in there. It feels like I am floating around in the open air when I am laying in bed.

I have always felt that I could live happily in a tiny home (that is, if I was able to part with some of the "junk"). I also thought that this was probably a character flaw of mine according to our society. Houses are built so large now--ours is from 1985 but still 3,000 square feet--it seems like living in a behemoth should be a normal way of life. Never mind all the earth's resources that it takes to maintain and run this house.

Our home in Illinois was 1,300 square feet. I was living happier in it. We were all closer. My bed was right next to the window where I could see and hear the oak leaves tap against one another every morning. I had birds to wake me and I could see strands of caterpillar silk reflected in the early sunlight.

I miss the simple life.

Rude Pencil

I found this pencil while unpacking some boxes in my room. Yes, that's right, I am STILL unpacking. That is beside the point.

I never really noticed or cared much about it--probably got it for free from some job fair back when I was a new grad--but now the message is so poignant to me, I am going to place it in one of my memory boxes so that it will last forever. Go on Southern nurses, remind me how rude us Northerners are. Wait a minute, I can't really consider myself a "Northern Nurse" anymore, now can I? Well, I will always be one in heart and spirit. Love live EICU!

expressing yourself

In ER world, nurses see lots of creative and innovative ways that patients choose to "express themselves." Why hold your anger inside when it can only lead to heart disease and aneurysms? Let it all out in the ER. The nurses are trained to therapeutically address your concerns. We are caring individuals.

Some ways that our patients like to release their pent-up feelings and emotions:

1. Tossing the written prescription on the floor in front of the nurse's station and storming out, all because the doc wouldn't write for Lortab or some other narcotic that the patient could sell on the street. Minutes later, housekeeper finds the word "bullshit" scribbled on the stretcher mattress.

2. One of my favorite nurses likes to advise his patients upon discharge to "drink plenty of water, eat your vegetables, and wear your seatbelt at all times in the car." Problem is that obese women who come visit us with barely a cold don't want this advice. "I sat in the waiting room for 4 hours just to be told to eat my fucking vegetables!"

3. Triage assessment on a patient brought in by ambulance goes like this: patient transferred to bed with help of EMS personnel, nurses assist patient into gown and instruct patient to lay down so that we can take vital signs, patient purses lips together and blows out a spitball straight into the air while two nurses are hovering above attaching electrodes. Or sometimes, the wall gets decorated. Safer for the nurse at least.

4. Phrase of the week: "I don't care." I don't care about this shit, I don't care about what you are prescribing me, I don't care what you say even though I myself chose to come here, I am not being admitted, I don't care if I have to pay the hospital bill out of my own pocket if I sign out AMA because you know that I won't pay it anyways.

5. Patient is bleeding profusely from surgical dressing, chux upon chux pooling up with blood. "When will I stop bleeding? Can I take a bath when I get home? Why do I have to stay here?" Fed-up Dr. Q responds with "I can't tell the future." Yes sir, go on home now, get blood all over your car and have your wife call EMS when you decide that you would rather bleed in the hospital.

Now I know why we studied therapeutic communication in school. Because it works so well in the ER. Patients always respond positively to logical reasoning there.

Remedial Composting 095

Let us, just for a moment, forget that it has been in the 20's down here in Tennessee for the past few days. Pretend that nitrogen is infusing all those weeds and unidentifiable green things known as "forbs" with power so that they take over the lawn. Let's ask a few random questions about composting.

1. If the toddler/preschooler throws a 2mm-thick fruit leather down because "it's too sticky!", and it becomes stuck with dog hairs that have been on the kitchen floor for awhile (quite a long time), will this piece of fruit leather then proceed to decompose in the compost pile?

2. What about peanut butter? Or will my dog get to it first?

3. Macaroni and cheese? Does the expensive organic kind break down faster?

4. A pumpkin from last Halloween? Or should I just keep rolling it around the pile in hopes that a raccoon will eventually carry it off?

5. Chex Mix? Does anyone think that the powdered cheese that's stuck on there will affect this process adversely?

6. Bills, if they are finely shredded?