What Nurses Deal With At Work

by Robert Schnell

Nurses deal with body secretions, increasing violence, dysfunctional families and disease everyday at work. Many times they go home exhausted, bruised, and fatigued only to discover urine, vomit, blood and stool on their shoes, shirts, pants and even in their hair. Patients (and even coworkers) are becoming more unpredictable and violent. I suppose it is a sign of the times. Don’t waste time trying to get nonmedical family and friends to empathize. Their only focus is MONEY … your steady paycheck. When discussing your job with them we suggest using a different value system for their understanding. For example, “That car you want cost 6000 code browns.” (A code brown being an incontinent stool … takes 30 minutes to clean up. At your current hourly wage it will take 6000 to pay for a car.)

“Cool new cell phone. They’re on sale this week for only two black eyes and a kick in the head.”

“Groceries cost 14 incontinent bed changes, two ripped out arterial lines with bloody floor mop up, an episode of projectile vomiting, and one abdominal wound dehiscence. Grocery prices have done up.”

“I filled the gas tank for one diarrhea stool off per gallon. Only took ten gallons to cap it off.”

See that roll of toilet paper on the patient’s table? Consider each section a five dollar bill. It is gonna pay for the orthodontist and the kid’s braces. Should take about three or four rolls. Rotten, crooked teeth take a lot of butt wiping to straighten.

Understanding the true value of things will make others appreciate those things much more. At least that is our current working theory.

Routine New Admission: “CALL SOCIAL SERVICES STAT!”

My Greatest Concern: Climate Change

by Robert Schnell (tree hugger)

I used to follow news about our politics, economy, unending wars, and quest for world dominance. At times I even had the topics rated from most concerning to least. All that has changed now. I believe the scientists and their reports on climate change. This is a worldwide emergency that eclipses all other concerns in my book. It has the potential to render the planet inhospitable to life. A potential fast becoming a reality. One has only to watch the fire devastation in California and now Australian.

As a kid whenever I saw a bull dozer clearing land and knocking down trees I got bummed out. It was an unexamined and unexplained melancholy. No mystery today. I fully appreciate the importance of trees in addition to clean air, water, and land but up against money, greed, corruption, pollution, warmongering, hubris, hegemony, world conquest, and unbridled narcissism, nature doesn’t stand a chance.

We exist in a bubble. News blackouts in the United States are proof of that.

I did notice one glimmer of light. The American media black-out vacuum was filled by bloggers, The Guardian, and a number of other sources. It gave me hope. Write on!

Original Nursing Cartoons

By Robert Schnell RN (and his various pen names)

Microcosm of society.

I had worked with nurse “hair loss” for over a decade, having no idea she was a “Jeckyll/Hyde” until I overheard this exchange she had with another co-worker she was trying to recruit to care for her father post op.

I couldn’t believe my ears and short of an audio visual recording have no proof I heard what I heard. Over the years I have encountered professional jealousy, envy, career vindictiveness, and anger but “slit your throat” was a whole new category of whacko in my book: especially from a registered nurse. From that moment on, until her retirement, I gave nurse “Alopecia” a wide berth.

Bull S#!* (BS), More S*^t (MS), Piled Higher and Deeper (PhD)

On a lighter more cheerful note…If you are lucky, you have what has recently become fewer and further in between….THAT GOOD SHIFT…the one that made you glad you became a nurse in the first place.

“What Are You Doing Now?”

A relative asked me that very question yesterday. My answer was simple. I said, “Nothing. Absolutely Nothing.”

At this stage of the game I am a guilt free spectator. Paid my dues, did my time. I sit back and watch whatever unfolds. I refuse to engage or intervene. But it took me a while to get to here. 44 years all total. 38 of those as an RN, the last 35 in various intensive care units. Critical Care. Today I am that spectator watching a younger generation do what I did in hospitals while juggling a house mortgage, marriage, children, taxes, coworkers, baby sitters, education loans, weddings, funerals, kid’s college, divorce, child support, various bills … you know … deal with life. Its ups and downs.

Lately I have noted political mudslinging, unusual weather patterns, receding glaciers, melting polar ice, rising oceans, warming seas, droughts, floods, fires, and crop failures. Ah well.

Every week it seems another celebrity of my generation passes away making me all to well aware of my own ticking clock. Yup. Ahhh well.

All that aside, there is nothing I wish to do, accomplish, or win that compares to what I currently have; peace of mind and solitude. I sip on a freshly brewed cup of morning coffee. No schedule on the horizon. As the day progresses I play it by ear till bedtime. Sleep another night through and repeat. As my buddy says, “Shampoo, rinse, dry, comb, repeat.” Pretty much sums it up except the combing part. Why comb?

I think I will take a little walk. Talk at you again later …

Open Heart Surgery Recovery

I spent a great deal of time recovering post op open heart patients in my nursing career. To learn this skill there was one article that was particularly helpful in Heart & Lung: The Journal of Critical Care written by Ann P. Weiland RN, MS and William F. Walker MD titled “Physiology Principles and Clinical Sequelae of Cardiopulmonary Bypass” (Vol 15, No.1, pp 34-39, copyright 1986 by C.V. Mosby Company). When pressed to do inservices or teaching new staff the recovery of open heart patients this was my “go to” reference of choice. Since that time the materials used and components of the Cardiopulmonary Bypass (CPB) machine have changed and improved but the human physiology and principles addressed in the article are the same. The “physiological derangements” and “altered cellular biochemistry” seen with patients who have undergone CPB persist for a time during the post op period. During my 35 years in the ICU Ms. Weiland’s article stood the test of time. This reference prepared me for the changes I would see in the first 24-36 hours as the patient normalized after undergoing cardiopulmonary bypass during their open heart surgery. I wished I would have written a thank you to Ms. Weiland RN and Dr. Walker MD for their article. It helped me enormously in dealing with, understanding the complexities, and treating patients recovering from open heart procedures and was a great reference over the years.

Teaching Poster Illustrating Pulmonary Artery Catheter Pathway through the heart.

The Train Wreck ICU Admission

A Little Background: 85 year old white male with a history of metastatic cancer to the bowel, liver, and lungs, primary site unknown, 65 pack year history of tobacco abuse, still smokes, chronic obstructive pulmonary disease (COPD), type II diabetes, severe peripheral vascular disease, active ETOH abuse, quart of gin a day, pedophilia, PTSD, benign prostatic hypertrophy, chronic GI bleeding, esophageal varices, peptic ulcer disease, recent small bowel resection, bipolar depression, schizophrenia, dementia, idiopathic cardiomyopathy with ejection fraction of 15% on a good day, severe congestive heart failure, brain natriuretic peptide (BNP) routinely 3000 pg/ml, hepatitis C, hemorrhagic pancreatitis, cirrhosis, chronic kidney disease (stage III), and neutropenia after completing 3 rounds of intensity modulated radiation therapy and chemo (vincristine, Cytoxan, doxorubicin and methotrexate regimens). Drug Eluting Stent deployed to the circumflex in 2004, aortic valve replacement with CABG x2 in 2006, bilateral fem-pop bypass, electroshock therapy, TURP and left ureteral stent placement.

The Patient presents to the emergency room today from nursing home with urinary catheter in place, shortness of breath, and flu like symptoms. He is immediately intubated and transferred to the ICU under pulmonary service. He is a full DNR (Do Not Resuscitate) with an iron clad advance directive. No defib, no compressions, no meds, no intubation (which we did anyway), no invasive lines, no nothing.

This is a teaching hospital, this is what we do…

“That is some concentrated looking urine … better send for a urine UA and urine culture and sensitivity ….. blood cultures too!”

Full court press folks. Wait till the Power of Attorney for Health Care shows up. Fireworks for sure.

Scuba Diving Nurses

Cavern Diving In Missouri

In Missouri I was certified as an Open Water Diver in the early 1980s and lucky to get stationed in California while serving in the Navy. There are pristine dive locations all over the west coast. Lajolla, Catalina Island, Channel Islands, and Leguna Beach come to mind. I was stationed at a naval hospital in Oakland and a group of us divers use to head to Monterey for an occasional weekend of diving. We had access to a Zodiac Inflatable boat and dove off shore near Pebble Beach. There was four of us and we would pair up. Dive partners are important and it is good to have a dependable, reliable partner. I was new to diving and this was not fresh water but salt water with surge. Big difference. I was a little self conscious and hoped I would make a good impression. The group I was with were all experienced, veteran ocean divers. When they heard I was certified in Missouri they laughed, “Lot of great diving in Missouri is there?” Compared to the California diving scene the ribbing and sarcasm was noted.

I paired up with Becky. We worked together in the neonatal unit at Oakland Naval hospital. The zodiac was owned by one of the residents in the unit and he was a avid diver. He paired up with a diver friend of his. They dove this location often.

I was a little nervous in this company, at first, but confident in the skills I had acquired. They must have accepted me because I was invited for many trips with this group.

Becky never said much after our dives so I figured no news was good news. I was in. After one of our dives she handed me a piece of paper that put a smile on my face when I read it 32 years ago. I ran across it the other day. Smiled again.

The world of late seems angry, and rushed, with way too much emphasis on career and materialism. Maybe it is time for another 50 foot dive. Now where is my old regulator and has anyone seen my car keys. Bet they are next to my coffee…somewhere.