Monday, November 22, 2010

I like medical terminology

Yup. I really do. I use it every day at work and I've found that the longer I do it what I do, the more it bleeds over into my personal life. I tell Hugo he can repeat the dose of Tylenol Q1 hour, prn. Every time I see that ridiculous infomercial for the fitness made simple DVDs it makes me laugh hysterically, because the big logo, FMS means something very different than fitness made simple to any healthcare worker. You see, we have this thing called a fecal management system that we use on people having profuse watery diarrhea (you'd be surprised by how many of our patients do). It's a plastic hose with a big bubble that gets inserted into a patients, well, rear end. The bubble gets inflated with a fairly large amount of water to hold it in there and Presto! You have cut your bed bath count down significantly, as the liquid stuff drains into a bag rather than into the bed and all over the patient. It's revolutionized the care of the cdiff patient (more medical jargon).

The FMS inservice lady came recently to update us on a few advances in the use of the device (that would be such a rewarding job, wouldn't it?) and she was trying to quiz me on the thing. It turns out, I'm kind of an expert. I took all the wind out of her sails. She was like, "And does anyone know how many cc's exactly your supposed to instill in the balloon?". "45" I answered immediately. She smiled at me, graciously. "Very good. And do you know what this port is for here on the side.". "Irrigation" I shot back. Her smile was wearing thin. This was what she got paid for darn it! She came back at me with everything she had. "How long is the FMS device approved for continuous use in a patient?". I shot it out of the park. "29 days!" We haven't seen her back since then.

One other fun story about the FMS. I was eating my lunch in the break room one day at the little table we have back there, back in the days before I transferred to night shifts. Dr Rodriguez, one of the hospitalists, came back to ask me about a patient. I happily updated him as I chewed away on my sandwich. Suddenly I realized he wasn't paying attention to me. "What is that?" he asked in disgust, pointing to the bulletin board, which is located right over the table, so you are kind of staring at whatever happens to be posted up there at the time. "That"
was a fairly graphic diagram of how to insert the FMS into a patient. I realized in amusement that I had been unconsciously looking at it every day while eating my lunch without ever realizing just how disturbing of a thing that is.

Anyway, today I was laying there in the dentist chair getting my mouth worked on. The tables were neatly turned on me. I had my mouth open as wide as I possibly could (with frequent semi-annoyed requests from the dentist to open back up nice and wide. He was working on one of my very back teeth for a good hour and a half. I had just come off a 12 hour night shift. I was freezing cold and shivering from all the cold water that the drill sprays out all over. My jaw was trembling uncontrollably from all the strain of trying to hold it open that wide for all that time. I began mentally reviewing all the mean things I had done the night before to my patients. This was obviously my karmic payback. There was the little confused guy who pulled his ng tube out (a plastic tube that gets shoved into someone's nostril and down the back of their throat, into their stomach, used for various reasons on a variety of patients). I had to replace it...twice. There was blood involved. He didn't enjoy it. There was another confused patient of Molly's, who had to be forcibly restrained from pulling her endotracheal tube out (yet another of the wonderful tubes that we, as nurses, are charged with keeping in patients who very frequently try to pull them out). There was an ugly code I was involved in that did not end well. All in all, I pretty much deserved whatever the dentist could dole out to me. Plus, I was laying there with no idea what was actually going on in there, which may have been the hardest thing of all for me to deal with. Finally, the assistant murmured something like, "are you ready for the temporary?". "No, not yet" Dr Dell replied in his deep baritone voice. "I still have to reduce the lingual.". I felt myself relaxing immediately. I had only the faintest of ideas as to what exactly reducing the lingual meant, but for some reason it helped me out a lot. Medical jargon, you know?

Tuesday, November 16, 2010

I'm switching doctors

I decided today that I want to get a new doctor. I already picked her out. It's Dr. Mas, my kids' pediatrician. I know, I know, I'm too old. Last time I called my own doctor, about an annoying little issue I was having, I mentioned to the nurse on the phone that maybe I should make an appointment to come in, since I was due for a check-up anyway. She laughed. "Oh, I don't think well be able to fit you in until after the first of the year, Lauren" she said. Ok, but why was it funny? Why is it so amusing that I might actually think I could have a legitimate medical concern and come in and be seen to have it taken care of?
Let me explain why I want to go to Dr. Mas from now on. I called there this morning, because Fiona has a little bug and is running a temp of 102-103, which is just a tad higher than what I think is acceptable in my one year olds. The nurse responded to my call within a half hour, though I emphasized to the secretary when I called that it wasn't urgent. I explained my concern when she called me back and said, "I was just wondering if I should bring her in so someone could take a peek at her?". "Yes, I think you should." she responded immediately. "Is 12:15 ok for you?".
Last time I called there, to find out if I could give Fiona the higher dose of Tylenol yet, the nurse urged me, "Don't hesitate to call us tomorrow if the temperature isn't better, or if you just want Dr. Mas to have a look" (tomorrow was Saturday). "Dr. Mas will be here till noon tomorrow." My kids have a doctor who works on Saturdays. No fair. I want her for myself. The well-child waiting room has a flat screen television with Shrek playing most days. They give you a sticker even if you're not totally brave when you get your shots. They treat the customer like, well, a customer. My doctor's office, bless them, treats me like a complete nuisance.
The interesting thing, as a nurse myself, that I notice about this situation, is that the doctor herself (or himself) doesn't set the tone for this sort of thing. The average time spent dealing with the actual doctor (even Dr. Mas) is negligible when compared with the time spent talking and interacting with the office staff. The nurse who calls me back. The secretary who takes my call in the first place. The person at the desk who talks to me about billing and setting up new appointments. These are the people who make or break your day. As one of those people myself, its a constant reminder that, even though I rarely get credit for either making or breaking someone's day, the power to do either is in my hands. Nobody wants to be sick. Its a real pain in the neck, and often happens at the worst possible time. In the end, though I don't in fact have the option of switching my care to the pediatrician, I do have the option to take my business elsewhere. Someday, maybe I'll find an adult practitioner whose office treats the little kid inside.