Grand Rounds Information for March 7, 2006

UPDATE: HEY ALL YOU GRAND ROUNDS SUBMITTERS, I HAVE MONDAY OFF SO I HAVE BACKED UP THE SUBMISSION DEADLINE TO 1700 (5:00 pm). AND BLESS MY COLLEAGUE-WHO-IS-GETTING-HER-PHD-IN-NURSING FOR SWITCHING WITH ME!

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I call this composition "Homeless Man Diagnoses Appendicitis in ER Waiting Room With Mother Draped in Blanket While Child Freezes With Wreath on Head".

There was no HIPPA back then, you know.

Now, regarding next week's Grand Rounds here at Emergiblog.

I will be doing the majority of work on the submissions over the weekend and would appreciate all submissions by Monday morning, 1700 (5:00pm) Pacific time.

Please don't wait until the last minute or visions of Eneman will haunt your dreams forever!

The theme will be "Grand Rounds in the Emergency Department" and because no one is ever turned away from the ED, all posts will be included in one of the triage categories.

I shall say no more.

Except that you should send all submissions to: kmcallister911 at yahoo dot com.

By the way, that is Hippocrates up there.

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I was going to ask for pity on myself because I have to do three twelve-hour shifts in a row this week to make up for the time I was in Portland.

Then I thought of all the residents and registrars out there who would split a gut laughing at someone complaining about twelve-hour shifts with actual sleep in between each one.

Guess I don't have it so bad after all!

How To Freak Yourself Out Via the World Wide Web

Write what on the chart?

She's in love with the neuro surgeon who doesn't know she exists?

That she'd rather be waxing her bikini line than working at this particular moment?

That she'd like to dot her "i"s with tiny hearts but they told her to stop?

Would you believe this was actually part of an ad for razor blades?

It was.

All she has to do is write "Patient states less pain and skin irritation when "x" razor is used."

There, problem solved.

What a wimp.

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Some advice from a person who has been there, read it all and freaked out.

Do NOT search the entire known world via the internet if you or a loved one is diagnosed with a medical problem.

An abbreviated search is fine. Stick with WebMD, perhaps the site of a national organization devoted to patients with that specific diagnosis (with their approved links) or a patient oriented medical site that will give you the information you need without giving you every nasty statistic, horror story, photo or urban legend that will scare the hell out of you.

You CAN have too much information.

I did. And I had needless anxiety for weeks.

If it can happen to a nurse, it can happen to you.

An informed patient is a knowledgable patient. An over-informed family member is a heart attack waiting to happen.

On the upside, I am now an self-designated expert on any possible cyst your gonads can produce (and what's inside them), but it came with a virtual encyclopedia of unnecessary, frightening information on ovarian cancer, testicular cancer, cancer staging, wigs for cancer patients.

You get the picture.

By the time I was done I was pretty sure every living thing in the house had ovarian cancer, including my husband.

All for two ovarian dermoid cysts the size of quarters.

The moral of the story? If you need information, look at a few sites and talk to your doc if you have questions. Don't go searching for information you don't need to have.

Trust me.

Oh, and by the way, I am also quite an "expert" on parasitic twins!

Don't ask.....

Grand Rounds Makes a Blog Call

No riffing on this photo.

It kind of made me melancholy for the "old days". "A symbol of American strength." Wow!

I actually had a primary physician who would take care of generations of patients in the same family. They called them "general practicioners" back then. He delivered me and took out my tonsils 5 years later.

My parents had to switch to Kaiser when I was six and I became a medical record number.

My old doc is still around, albeit in a very reduced practice. His son followed in his footsteps and is now also a popular doctor in this area.

Tradition.

Speaking of tradition, it is Tuesday!

And Tuesday means it's time for Grand Rounds ! This week Dr. Bard Parker is hosting at A Chance to Cut Is A Chance to Cure and I am honored that an Emergiblog post is included.

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Guess what?

Next week I'm the host for Grand Rounds!

I guess you could say I'm just a wee bit excited with a bit of nerves thrown in! LOL!

This is going to be a blast - I'll be posting information regarding where to send your submissions and the theme and when the party starts.

Hey, what can I say? I love this stuff!

Hot to Trot

My chances against pneumonia are great!

This guy might have a good chance against pneumonia, if that was his problem.

He looks like he's having a massive anterior MI.

Or his wife's meatloaf keeps repeating on him.

I think he's having an acute anaphylactic reaction to the decor.

Who puts an ass (pardon me, I meant donkey), complete with a saddle, on their end table as a decoration?

The child will need theraputic counseling for years after this traumatic attempt at fever assessment.

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Do you know, when a patient tells me they think they are running a fever, I instinctively feel their forehead and then I take their temp?

I have no doubt that the first humans did the same thing. I imagine this scene, set in a pre-historic cave:

Caveman: "Feel hot!"

Cavewoman: "No. Have pain in head."

Caveman: "Not that. Skin hot!"

Cavewoman: "Me feel face." (Puts hand on forehead.) "Skin hot. Eat two of berries. Call giver of health when light comes."

Caveman: "Me sick. No care for self. Must have all things done."

Sorry guys, but some things never change.

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And now it's time for an Emergi-disclaimer: the following is not intended to be medical advice (1) because I'm not a doctor and (2) you should always check with your child's pediatrician for any illness or concern. There, now that that is out of the way:

Do you run into your emergency department in a state of panic because your child has an "extremely high" fever of 101 degrees?

Do you take your child's temperature under their arm because, well, who wants to do a rectal temperature?

Do you get nauseated at the thought of taking a rectal temp?

Do you become faint when the triage nurse takes your child's temperature and tells you that the number 40.6 centigrade is actually 105 degrees?

Are you concerned when your child's temperature does not "break" after a dose of Tylenol?

Are you amazed when the temperature comes back to its pre-Tylenol level approximately four hours after the last dose?

What, you say? You can give ibuprofen for fever?

Does the fact that your child even has a fever cause your pulse to race, your breathing to become labored and your anxiety level to skyrocket?

You, my friend, are suffering from acute fear of fever, or, as it has been coined in the literature I'm familiar with, "Fever Phobia".

You are not alone.

Here are some things to keep in mind. These are things I've picked up regarding pediatric fevers in the ER and during my stint as an advice nurse in a pediatric clinic.

• Fevers are not dangerous.
  

• They are the body's way of fighting off an infection, either viral or bacterial.

• Fevers are more likely to be bacterial and should definitely be evaluated if

• They last longer than three days.

• They go over 105 degrees.

• The exception to the rule: fevers in any child under 8 weeks old should be evaluated immediately by a physician.
  

• The height of the fever is not as important as how the child is acting/looking.

• Febrile seizures are the scariest things you will ever see as a parent.
  

• They are also harmless.

• Usually it is related to how fast the fever rises or drops.

• They will stop on their own.

• Turn your child on their side to allow any secretions to drain.

• Protect them from injuring themselves on surrounding items.
  

• The child should be evaluated immediately after the first febrile seizure.
  

• The doctor will need to confirm that the seizure was truly due to the fever and not an underlying medical condition.

• Discuss with your pediatrician what steps you should take if your child has repeated febrile seizures.
  

• Both acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) can be used for fever.

• There is some difference of opinion on whether or not both medications can be used together, i.e. alternated. Ask your pediatrician what they prefer you to use.

• Pediatric dosages are based on weight. The dose your child took six months ago will not be the correct dose today. If your child's weight is not listed on the bottle, call your pediatrician or an advice line to get the correct dosage for the weight.

• Ask your pediatrician at what age they suggest using Motrin. It has been my experience that ibuprofen is not used under six months old.

• Expect the fever to return as the medication wears off. It will.
  

• Do not wrap your child up if they have a fever.

• Right: a diaper and light covering - just enough so they do not shiver.
  

• Wrong: a diaper, two onesies, a terry-cloth one-piece with "footsies", a sweater, a blanket-sleeper with "footsies", a coat, a hat and a fifty pound afghan hand- crocheted by grandma. At the same time.

• Most children with fever will not want to eat, but they will be thirsty. Fluids are important.
  

• Encourage them to drink as much as they want of whatever they want.

• Make sure the fluid has calories in it. That sounds silly to mention, but offering diet sodas will not contribute calories or nutrition.

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When I worked in pediatric triage, my facility used protocols written by pediatrician Barton Schmitt, MD. I have to recommend this book as one of the best books on child health that I have ever read. It is based on the same protocols we used at the clinic. I have given it as a gift at at least six baby showers. Apparently it has been updated in 2005. Here is the amazon.com link for those who are interested:

Props To Providence Portland Medical Center

This should be interesting.

I am typing on an old Windows desktop computer and I am a die-hard Mac person.

No offense, but yuck!

The picture to the right is of Providence Portland Medical Center in Portland, Oregon. One of the top 100 hospitals in the United States.

Now I know why.

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I am proud to announce that my daughter has given birth to two NON-CANCEROUS ovarian dermoid cysts. I told her that she had a lot of folks she didn't know praying for her; she gave me permission to give this update and to give her thanks to all of you who gave us "virtual" support.

Pathology reports are pending, but everything looked okay per her surgeon, and the tumor marker was within normal limits.

It's hard to know where "nurse" ends and "mom" starts. For instance, her doctor gave a fantastic "inservice" on ovarian dermoid cysts after the surgery was over, which I found fascinating. No cancer involved. We shook hands and I walked into the elevator.

And burst into tears of relief.

I knew I was worried, guess I was more scared than I wanted to admit.

I have named the cysts Barry and Bridget.

I have asked my daughter to make sure that any future grandchildren be made of more than hair, calcium deposits and nerve endings.

She has said she will try to comply.

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Due to some nausea issues and an unexpected allergic reaction, we stayed the night. I was able to stay in her room with her.

This was the Taj Majal of hospitals.

• A huge, sprawling facility that color-codes their elevators to make getting around easier.

• A "food court" open until 0330. With Diet Pepsi!
  

• An "IV" team that inspects all IVs in house every 24 hours for inflammation or infiltration and restarts prn

• A day ratio on the med/surg floor of one RN to a max of 5 patients.
  

• The names of your nurse and your CNA on a large board (not unusual, I know) that also included the name of your pain medication and the last time it was given.
  

• The nursing care was impeccable.

• Pain was addressed repeatedly and handled immediately in both Short Stay and on the med/surg floor.
  

• Call bells answered within seconds.

Needless to say, I was impressed with the overall service, but the nurses were the best. They looked professional, they were compassionate, I can't believe the speed with which everything was handled. This is how nursing should be.

If I ever move to the Portland area, this is where I'd be working.

So here is my official online "thank you" to the nurses and staff of the Short Stay surgery unit and the 3G med/surg floor of Providence Portland Medical Center. You guys rock!

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Speaking of rock, we made it to the room just in time to catch the last 45 minutes of "American Idol" and while my daughter slept the sleep of the narcotized, I voted my fingers raw for both Ace and the grey-haired guy. Thank god for cell phones.

And a pox on the house of the stupid network executive who decided to run the women's figure skating competition against "American Idol". Idiot.

Oh, and I also kept a strict tally of my daughter's I&Os.

Hey, I'm a nurse. I've got to do something.

There's No Test At Grand Rounds!

Obviously the guy in the first row on the right did not study.

I bet he hates the guy to his right, who probably studied non-stop for five months and has no social skills to show for it.

The guy in the middle of the second row looks like Tony Soprano got him into medical school.

But there is no test for this week's Grand Rounds over at Dr. Andy's place.

Just a lotta good linkin' and a ton o'good information.

I'll be reading it from Portland tomorrow night, from a desktop computer with a dial-up modem.

It will feel just like the old days when I had to sit at the desk to do any computer work.

Now, I just take my laptop anywhere I want with my wireless AirPort Express and cable
modem!

Better living through technology!

Trying To Be A Nurse, But Really I'm Just A Mom

Oh no!

It's menopause!

She's gonna blow any minute!

The father looks ready to grab the kid and run at the first sign of a hot flash!

And he thought her PMS was bad!

She probably has just read "The Feminine Mystique" by Betty Freidan and she wants to escape the confines of her middle-class prison and decide to "find" herself.

She'll refuse to make dinner.

She'll make her husband iron his own shirts!

My god, she might even enroll in a college class.

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Actually, I really am a bundle of nerves right now.

My eldest daughter is having surgery and I'll be on a flight to Portland to spend a week with her while she recouperates.

Now, I am usually strong in these situations, but I made the mistake of reading too much on the internet (you really can have too much information) and this is not a good thing.

A previous appendectomy found a "carcinoid tumor". The doctor said it was a "miracle" that she had her appendix out when she did, because that would have turned into a slow-growing cancer that would have affected her intestines and liver.

Whew! Bullet dodged.

That time. I've only heard a doctor use the word "miracle" twice in my presence. I'll tell you about the other time in another post.

Without divulging too much information without her permission, let's just say that part of the blood work that was done today was a tumor marker for cancer.

I'm trying to be "A NURSE", but today I'm just "a mom" who is very scared.

The next time a family member goes into surgery I will wish to be totally ignorant.

I Blog, Therefore I Say Thanks!

I started blogging because I realized I knew enough about something (nursing) that I could actually contribute to the blogosphere. I also learned that if your write well enough (see The Bleat by James Lileks), everyday life can be interesting.

What I didn't realize is that I would get so much more out of blogging than I could ever contribute.

Prior to launching Emergiblog, I had never read a single medical or nursing related blog. My daily reads were Hugh Hewitt, Instapundit, Lileks, Fraters Libertas and Powerline.
With the exception of Lileks, they were all politically inclined.

One day I clicked on a link to "Grand Rounds" and I realized there was an entire, worldwide niche of blogs related to health care.

It has changed my life.

And not because I sit around all day and read blogs. Although I do. As far as I am concerned it is no different than sitting reading a book all day and no one gets upset about that, do they? (This last sentence was intended for my hubby who won't read it anyway.....)

Here's how my life is different since I began to read the medical blogosphere:

• I have developed a deeper respect for physicians now that I have a deeper understanding of what they must endure to earn the right to practice their profession.

• I realized that doctors are people. They hurt, they worry, they ache and they get sick just like the rest of us.
  

• Why it took me 28 years to figure that out is beyond me.

• I now cut my docs a lot more slack, knowing the responsibility they shoulder.
  

• I have learned that health care concerns are the same everywhere in the world. We may have different political ideas but whether we are in Iran, Singapore, Israel, Australia, Canada, England or the USA, when it comes to health care, our hopes and dreams are the same.

• I have been inspired to "read up" on diseases and actually have a huge pathology book sitting next to me on the couch. The enthusiasm of the nursing students and the fact that some of my future colleagues are beginning their journey in their 30s and 40s makes me energized about making sure I am up-to-date on the latest nursing ideas.

• It has helped me to re-appreciate my profession and increased the pride I feel about being a Registered Nurse again. Sometimes, over the years we can forget why we wanted to be nurses. I remember.
  

• It has also made it fun to work with the student nurses we now have in the ER

• I have more of an idea of how things work behind-the-scenes: in hospital administration, physician credentialing, pharmacology.

• It has brought back memories of patients I had not thought of in years and patients who I thought I had forgotten. The more I blog, the more I remember.

• I have read the blogs of patients and learned so much more about what they go through and what they expect of me as a caregiver. I've always said, I learn the most from my patients.
  

So basically, I get so much out of reading the blogs of my colleagues in medicine, nursing, pharmacy, administration that I'm sorry it took me so long to get in the swing of things.

But I am proud to be considered one of the health care bloggers. I imagine I'll be blogging about nursing for a long time. Lord knows there is never a dearth of material!

Does This Cap Make Me Look Fat?

I'm confused.

This ad to the left is okay? Three hunky men drop their scrub pants to the floor and look like they meant to do it. No outcry? (Except maybe whoa baby!) These could be nurses, you know! Or the ER doctor standing next to you. Or the OR doc in surgery.

I may never look at a ER doc the same way again (hey, I said I was confused, not stupid....).

The ad does not hint at the occupation, they just assume everyone will think they're doctors. They could be RNs, OR techs, ER techs.....

It didn't even make a ripple on the waters of opinion.

But this ad gets everyone all freaked and offended and gets pulled off the magazine pages as fast as you can say STAT.

Why?

I admit that I was instinctively offended at the Maidenform ad but demurely stated, "Oh my!" at the Jockey ad. Okay, okay, I said "Whoo Hoo!" but not so loud that my husband could hear me.

At least the ad depicts the Maidenform woman as a doctor and doesn't assume she's a nurse, whereas the Jockey ad leaves the occupation (and not much else) to the reader's interpretation.

You know, I don't think I would want to know who wears what underwear at work. Especially if it's a thong...who on earth would walk around with a permanent wedgie? Then again for some of us, any underwear becomes a thong during the course of a shift.....

Sometimes you can have too much information about your co-workers (and your bloggers).

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I want my "uniform" back.

I want my cap.

I know it sounds old-fashioned and stupid and archaic and pretentious and (fill in your own adjective here), but I want people to know I'm a nurse on sight.

It isn't enough to have a name tag with an official-sized font on it. Half the time it's backwards anyway.

Three times this week I had patients ask me, even after my initial introduction as "their" nurse, if I was an RN. After I said "yes" the next question was, "How long have you been doing this?"

Huh?

Almost thirty fargin' years, bub.

I said it nicer than that.

But I am going to make some changes. My blogging colleague over at Third Degree Nurse got me thinking more about looking professional and about scrubs and how we present ourselves to patients.

So, I'm switching to solid color scrubs. No Peanuts, Spongebob Squarepants, American Flags, strawberries - yes that is what graces my ample self. No wonder the adults have to ask if I am an RN. I look like a creature from "Adult Swim" on the Cartoon Network.

There is a local hospital that color-codes their employees and the nurses are obligated to wear white. At first I thought that to be a stupid decision by administration, but now I am not so sure. I'm not sure if I can really go back to all-white, but it really isn't a bad idea.

And the cap. I've worn it before. The patient's respectful behavior quadruples. The ribbing that I take from my colleagues is unbelievable. But every person who sees me knows I'm an RN. I may wear it again, it works with any solid color scrub. I graduated from Ohlone College so my cap has a thick green and thinner gold stripe across the top, which was the sign of a graduate waaaaay back when "What's Happenin'" was what was happenin'.

It's time for a professional makeover. And I don't need Trinny and Susannah from "What Not to Wear" to help me.

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By the way, I passed my ACLS/BLS recertification with flying colors and got 100% on the test.
I worried needlessly, it was a great class.

I took hold of my new cards and gleefully walked out the door of the facility, only to trip on the doorstop and fall on my butt.

So much for looking like a professional....

Twenty Thousand Reads Under the "E"

Sometime during this evening, while I was working, the site counter for Emergiblog hit over 20,000.

I am floored.


I'd like to thank the following:

• My mom for her 500 hits.

• For all the Grand Rounds hosts who included Emergiblog in their posts, and to those who may not have included Emergiblog, but gave me the opportunity to learn from some of the best and to expand my horizons.

• Those who were searching for a 1976 Olympic Gold Medal Figure Skater's Haircut and thought they could find it here for their 500 hits.

• To Bora at Circadiana for my very first link.

• To everyone who reads Emergiblog, thank you so much for taking the time to read. Most of you are bloggers, you know what it is like to have someone appreciate your work. I am humbled by the number of readers who consider Emergiblog a place to laugh, cry, commiserate and learn.

• And to those bloggers who I have found and linked to - I look forward to reading you every day. The list is getting long! Monday may have to be doctor's day, Tuesday, nurses day, etc! LOL! I have just begun to link!
  

And finally, this blog was recently visited by someone who I consider one of the best writers of any genre in the business. Blogs, books, novels, podcasts, op-ed pieces, columns. You name it, they've done it.

I'll go as far as to say it wasn't Glenn Reynolds, but other than that I shall keep it anonymous.

To me it was like being a lowly law clerk having your brief read by the Supreme Court!

You know who you are....your visit was the highlight of my blogging "career". Thanks .

If this were the Acadamy Awards, the orchestra would have started playing now to tell me to shut up.

So I will.....except.....

And thanks again to everyone - I look forward to more fun and posting in 2006!

Certifiably Certifiable

She's baaaaack!

It's Beulah France, RN! Of New York!

The a nurse who made a career out of fondling toilet tissue.

The first nurse with an endorsement contract.

Now she is speaking to parents and teachers about the importance of toilet tissue to health.

Apparently it was no longer appropriate to use one's hands now that toilet tissue had been invented.

I'm trying to be delicate here.

Which is exactly the point!

If your toilet tissue is too rough it can irritate tender nether region areas.

Who wants to wipe with wood chips?

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Why am I blogging?

I don't mean that in a philosophical sense, I mean why am I blogging at 0133 am when I have a twenty-three page ACLS study guide sitting here on the end table.

And the class is Friday. And it's only a recert class so I have to actually be prepared when I get there.

At least I was able to download the study packet.

Only to discover I have the same book that I just purchased.

They sure grabbed us by the gonads when they made certification mandatory. I paid about $150 for a five hour class. At least this company also gives you a BLS card, too.

And then somewhere along the line I realized that every four years my BLS, ACLS, PALS, TNCC and NRP are all due within two months of each other.

BLS and ACLS are pretty self explanatory.

PALS (Pediatric Life Support) is also required by my facility, but it should be required at EVERY facility. You would be surprised at the number of ER nurses who are not comfortable taking care of kids with anything more than a virus. I'm not putting them down, it's just not an area they are comfortable in. The newborns with temps of 101. The tripoding, drooling epiglottitis patient (thank God I have yet to see that). The lethargic two-year-old that should be screaming at everything you do, yet lays there and just takes it. The croup patient who is retracting to the point that his supraclavicular area is tapping his scapula. The sick ones.

(Just a note: I had a doctor once tell me to never describe a pedi patient as "lethargic" in a chart, but to simply describe the behavior witnessed. Apparently "lethargic" is a trigger word when it comes to lawsuits. But that is true of most of nursing charting: you describe what you see, you do not label it - for the most part).

TNCC (Trauma Nurse Core Curriculum) is not required for employment at my facility, but stabbings and gunshot wounds don't always come in by ambulance. Sometimes they ar courteous enough to walk through the entry portal. Or as I've noted before, they can be in an MVA and three weeks later their spleen blows up. Trauma patients....they can sneak up on you like Dracula on a carotid. And lose just as much blood!

NRP (Neonatal Resuscitation) is also not required, but you never know when the only thing standing between you and a crowning head is....well....YOU!

Like the time a particularly assertive newborn pushed aside his mother's Victoria's Secret maternity undies and plopped on the floor. In the ER.

Or the time I stood there with a hand in a sterile glove watching the curly black hair of another little boy just one contraction short of landing in my hand. Oh, I had plenty of helpers, but they were all standing five feet behind me because, as the actress Butterfly McQueen so succinctly put it in that grand movie so very long ago: they "did'n know nothin' 'bout birthin' no babies!"

Hell, neither did I. I just figured that millions of babies have been born and this one would be unique because it was my hand that guided the head. I looked as cool as a cucumber and felt as calm as if I had an amp of adrenaline shot in my derriere. At the last minute the doc delivered the baby. It took me sitting down 20 minutes before my legs stopped shaking.

Hence, my wish to have NRP under my belt.

Alas, I am rambling. It is now 0206. I must study for my ACLS. I paid good money for it, I want my card!

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Oh, and for those of you who watch "American Idol" I have two things to say : (1) If I wasn't married, I would run off with Simon Cowell in a New York minute and (2) I have already picked the final twelve AND the winner of the contest so you can all save your votes and just enjoy the show. Thank you.

What Have I Done?

Okay, I know there are various ways to increase traffic, but I never thought that putting the name of "Dorothy Hamill" on this site would lead to Emergiblog being one of the top hits on the search engines for her name!

If you are here looking for a photo of Dorothy's new hair cut, welcome to Emergiblog. However, you will not find it. If and when you DO find it, please will you email me? My address is on my profile.

Emergiblog thanks you!

Do NOT Call Me At Work!

Figprune Coffee.

Can you imagine? "Why, yes, I'd like a Vente, decaf, one-Equal, extra hot, non-fat soy Figprune latte with whip and an ad shot of prune!"

And then I'd like the keys to the bathroom because that is where I'll be spending the next hour!

Who invented this stuff? Oh geeze, it was a local company, of course. San Jose.

Hmmm....looks like Google, God of Research shows them to be out of business.

Can't imagine why!

Figs + Prunes + Coffee = someone actually thought that would be a good combination.

And where is the coffee?? It's 54% fruit and 46% cereal grains. That's 100%!

Was coffee considered a fruit?

Where's the caffeine? Is it sludge? Do you eat it with a spoon?

Well, I hope they had a good explanation when they stood before the Great Starbucks Manager in the Sky.

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Don't call me at work.

I'm one of those people who can compartmentalize their personal and professional lives with a fair amount of distinction.

When I am home, I am really home.

I cook, clean, take care of the finances, listen to conservative talk radio, take care of the pets, the backyard gardening, the minor repairs, the financial aid forms that my soon-to-be-law-student-son insists were due yesterday, deal with the roller-coaster emotions of my 16-year-old daughter, and reassure my oldest daughter that even though she is undergoing surgery next week, she does not have ovarian cancer (and then say a prayer that I'm right).

In other words, I am mentally, physically and emotionally home and available to everybody for everything.

Actually, I sit on my butt all day long and blog. Or read blogs. With coffee. Or watch my "Aqua Teen Hunger Force" DVDs.

Thirty minutes before everyone is due home I run around the house like a madman so it looks like I've been slaving all day. It's a pretty cool set up, actually.

But at work it is another story.

I am completely and utterly engrossed in what I am doing. I am physically, mentally and emotionally available to my patients for everything. I don't even think about what is going on at home.

Until I hear those six words, "Kim, you have a phone call!", and those at home become beloved, adored pains in the derriere.

The following is a true representation of an actual conversation that took place in the mid 1990s when eldest daughter was still at home. The scene: hell in my ER with a critical patient deciding whether or not to code.

"Kim, you have a phone call!"
"Tell them I'll have to call them back!
"She says it's urgent and she has to talk to you now!"
(Oh no, I think to myself! Something bad has happened!)
"Betty, can you take over for one minute? I have an urgent phone call from home!"
"Hello, it's me! What happened?"
"Mom, do you know where the tweezers are?"

Oh no, you did not just ask that question.

"Don't you EVER call me at work again unless you or a close relative is DYING. Is that understood?"
"Yes, mom......geeze!"
Click.

Mean? Rude? Nasty? Non-understanding? You bet your sweet bippy I was.

I have been interrupted at work for the following:

We are out of cat food.
We are out of dog food.
We are out of milk.
We are out of bread.
We are out of cream cheese.
We are out of ice cream.
We are out of printer ink.
Poster board is required for project due tomorrow.

So, after a hard shift that never has never ended before 2330 for as long as they've known me, I am supposed to provide the above.

And then,

Hubby doesn't know what to take for his congestion (27 years of marriage: the answer has always been "Sudafed").

Eldest daughter calls from another state to ask what dosage of Advil to take. Funny, last time I saw her she knew how to read. Labels.

Son calls from another state to ask if he can put his newly required text on the implications of US foreign policy on the price of chewing gum on his student account.

Youngest daughter calls to say she hates geometry and she got a "C" on the quiz and she feels so dumb but she is getting into AP History next year and Billy flirted with her, but she really wants to ask Jack to the Sadie Hawkins dance, but Eddie is a better dancer and can she have $20.00 so she can go to the movies with 148 friends on Friday and do I mind if she sees "Final Destination 9" even though it is rated "R" but she has seen worse things in drivers's education and can I make sure her brown pants that aren't floods are in the dryer when I get home?

Sigh.

It's nice to be needed, but I want to smack them all.

At least now my husband says,

"Sorry to bother you, but...."

Love and Contemplation at Grand Rounds

It's Valentine's Day, and if you go over to Maria's blog, Intueri: To Contemplate you will find
this week's edition of Grand Rounds!

You will find a very eclectic group of links!
As usual, I'll be hitting them during my coffee hour later this morning.

There are new blogs to peruse and what are sure to be some controversial opinions in a very creative, funny format, after which you may:

(1) Call your significant other STAT.
(2) Devour the pictured cookie bouquet
(3) Take a cold shower.

Knowing me, I'd go for #2 because #1 will be at work and just the thought of #3 makes me hypothermic.

Alas, Emergiblog is not among this week's links, but since you are here anyway I shall wish you a happy Valentine's Day and invite you to peruse a few posts!

Blast From Our Past

This patient has cracks in his feet!

They could be serious!

Why they could be a sign of a tinea infection! Tinea causes athlete's foot!

Tinea also causes something that I can truly say I've never experienced.

Jock itch.

So why does this doctor have this patient's fungus riddled foot sitting on his crotch?

Now, you are supposed to rub Absorbine Jr. on your feet to stop the athlete's foot.

Does that mean you are supposed to rub it on your, well, jock area if you have "jock itch"?

What if you just itch and you aren't necessarily a jock? Did they call it "nerd itch"?

And what ever happened to Absorbine Senior?

hhhhhhhhhhhhhhhhhh

There have been many, many advances in medicine since I was born in 1957.

My children never had to go through mumps, measles, or rubella. I had all three. By 1970 there were immunizations for all of them. In my internet travels I found some photos and ads of just how things were different "back in the old days".


Somehow, I managed to miss the era of the "Quarantine" sign. I remember, having to stay in a dark room and not being able to even see my friends. For a week.

Spent my time watching the reruns of "The Mickey Mouse Club". And colouring. In the dark.

It was the week before Christmas break, too.

I was going to play the autoharp at the concert and I had a lead in the Christmas puppet show.

But we all went through it, there were no vaccines at this time.

My mother had to remind me of this when I called her shortly after I had my first daughter and reamed her out for not having me immunized like she should have.

How dare you make me suffer through all those childhood illnesses.

Ooops. My bad.

Ahhh, would that all vaccines taste so good!

I have distinct memories of lining up in the gymnasium of my local grammar school to get my "goodie".

That "goodie" would ensure that I would never get that most dreaded of childhood diseases.


Polio.



And here is why polio was so feared. Even to this day it makes me woozy to think of having to live in a contraption like this:

The iron lung.

If polio paralysed your chest muscles, you had to live in this, which was essentially a respirator.

Pressure changes inside the "lung" would cause the patient to "breathe".

Scared the hell out of me as a kid.


And through all the fevers,swelling and pain, my mom religiously gave me St Joseph's Childrens Aspirin.

Never got Reye's Syndrome.

Never knew anyone that got Reye's Syndrome,unless you want to count a character in "All My Children" in the early '80s.

But it is a devastating disease that can strike after any viral illness and they did find an increase when ASA was used in children under the age of 16. So now we use Tylenol. But "back in the day", this was the stuff that made us feel better. And besides, it was yummy.


So, what is wrong with this shot?

Right, no carseats!

This law is so new that when we brought our first baby home in 1980 we were not required to have one!

Emergihubby has a 1963 Ford Galaxy and they didn't even require seat belts in the back seat in those days.

And check out the nurse on the right trying to make sure she gets into the photo....

Sometimes I think we "baby" our children a little too much these days, but I will say that from a health perspective, they have it so much better than we did.

I hope someday there won't be a need for any vaccinations because we will have wiped out the majority of the illness that killed so many for so long.

Wishful thinking? I hope not.

Mama Gonna Clock You Out!

This is wrong is so many ways.

First of all, the groovy early '70s tunic. We're talking Osmond Brothers era here. People were still mourning the Beatles. Bras were smoldering, but not yet burning.

I never knew that the purpose of a nursing uniform was to cause a disturbance in the cardiac function of anyone with an MD who happened to be in the vicinity.

I must have missed that lecture in pathology.

The ad also assumes the doctor this nurse will be working with is of the male persuasion.

The only good thing I can say about this ad is that it shows a woman of color in a professional capacity. If my memory serves me correctly, I don't remember seeing a lot of that back then.

Of course, I could be wrong. It could be an ad for ensuring the health of our medical doctors by assessing their blood pressure every shift, and making sure that nurses act as "gatekeepers", so the physician is never stressed beyond his capacity to cope.

Pardon me, I have a strong urge to gag.

With all due respect to my male nursing colleagues, we've come a long way, ladies.

hhhhhhhhhhhhhhhhhh

A few posts ago I mentioned that the giant health conglomerate for which I (happily) work, decided to implement a new procedure that requires everyone to now clock in and out for both their shift and their lunch break. (Not the doctors; they are not hospital employees).

I find this to be professionally insulting.

There is a seven minute leeway in terms of signing in and out, which is good.

You can punch out at 23 minutes after the hour and still be paid in full or you can punch in 7 minutes after you are due into the unit and still be on time.

So, you're thinking, what's the problem?

Well, this seven-minute leeway does not apply to the lunch period. If you punch in one minute too late after your lunch break, you get docked 15 minutes of pay.

Being nurses, we have learned how to exploit the system.

Here's how:

• Rule One: Never pee on your own time. All urination is done while "on the clock" be it before or after your break is done.

• Rule Two: One nurse must make coffee before actually swiping out. This is so the rest of us may enjoy our cups without having to make it "off the clock".

• Rule Three: All food is purchased from the cafeteria before punching out. Most of us just run down there and buy what we want during the beginning hour or two of the shift so that it is ready for us on our "official" break. Plus, the first nurse can report on what is being served that day.

• Rule Four: all food is heated in the microwave on company time. Some of those meals take 10 minutes to heat up, allowing only 20 minutes to eat and digest, leading to acid indigestion and requiring us to sneak Maalox from the till. So you see, this is in the company's best interest.

• Rule Five: YOU DO NOT INTERRUPT THE NURSE ON HER BREAK FOR ANY REASON OTHER THAN THE DEATH OF ANOTHER NURSE ON DUTY, AND THEN ONLY IF NO ONE CAN WATCH HER PATIENTS.
  

• Rule Six: take the little timer thingy and time it to allow yourself 30 seconds to get to the clock to swipe back in.

• Rule Seven: Don't stand at the time clock waiting for just the right time to punch out. It makes you look like cattle waiting for the rancher to open the stall. Either punch out early and take the dock or keep working until it's time to go.
  

So, as you can see, we pretty much have it covered. I personally like to do crossword puzzles or that damned new puzzle, Soduku on my break, so I make sure that I have the paper folded "just so" and my good pen and that the couch in the breakroom is clear before I punch out.

Gee, just what I thought my life would be like as a PROFESSIONAL REGISTERED NURSE.

Run by the clock.

Bugged by Blogger

Quick note: you may see font changes in my previous posts. With the exception of the little ambulances, they are not intentional. I try to keep my font consistent, but it either makes it too big or too small, even though my font bar shows the right size. So either (1) Blogger has some bug that messes with fonts or (2) I am too stupid to figure it out.

Please bear with me as I plod my way through html hell.

Les Whining Miserables

Ahh, the famous Dr. Taillandier from France.

His patient had a headache and a feeling of tiredness. She also had bad skin and a severe case of the non-fatal, yet universally dreaded symptom of......coated tongue.

After a thorough evaluation and assessment, meticulously documented pictorally, the true problem was diagnosed.

Her intestines were unclean. They were tired.

The patient was constipated.

And our renowned Dr. T had the answer.

Fleishman's Yeast.

Three cakes a day.

For a minute I wasn't sure if you were supposed to eat it or shove it up the nether region.

You eat it. Blech!

Three cakes a day and your life will be pain free, your acne will clear up and your tongue will once again be presentable.

You will also auto-produce bread if you stand in a warm room.

(Disclaimer: Emergiblog is 99.9% apolitical. Any inference of an association between France and constipation is unintended. Thank you.)

hhhhhhhhhhhhh

It has come to my attention that a certain computer system used by our largest local EMS service will not allow my paramedic and EMT colleagues to access Emergiblog because it contains images of "intimate apparel".

I had given my blog address to one of the medics in a shameless attempt to solicit votes for the Medical Weblog Awards. Hey, when you are a Maurading Marsupial you do what you have to do, okay?

So now, all of the EMS personnel in the county in which I work, should they attempt to access Emergiblog, will think that I am modeling "intimate apparel".

This could make me very popular.

However, one photo of me in "intimate apparel" would be so bad that readers would actually take back their hits and my site counter would immediately hit -58.

My best guess is that when I ran, months ago, the old ad that showed a '40s nurse in underwear, I crossed a delicate line. We can't have our medics looking at that nasty photo while on duty.

So, hello to those EMS colleagues who are accessing from a different computer system, welcome, and I'm sorry I don't have any intimate apparel for you to peruse. I do, however, have a very cute scrub top I will debut next week, so if you like Winnie-the-Pooh, you may not be able to control yourselves.

You have been warned.

hhhhhhhhhhhhh

I'm not really miserable, but I was last night.

Twelve hours of hell.

Now, please understand that I work in the best ER ever.

As an example, when we give patients a "GI Cocktail", we put a margarita umbrella in it.

I'm not kidding! We really do! I even put one in the oral contrast for abdominal CTs. Makes the patients laugh, which is not easy when you have abdominal pain.

So it's a cool place. Homeless drunks found on the street who don't even know their own name request our facility.

Sometimes I wish we were not so popular!

So to put it in perspective, when I say I worked through a night of hell, in other ERs we are talking "business as usual".

Anyway, in the patients came. Lots and lots of them. Very sick ones.

If we were lucky, it was by ambulance because, at least in our county, they are practically cured by the time we get them (good field protocols, and good medics/EMTs). But when the really sick ones walk in with chest pain or are wheeled in by relatives, it's "starting from scratch" and it takes a lot more work to initiate their care. They came en masse.

The "walking wounded" have to wait, and they also came en masse.

And as luck would have it, I was Charge Nurse/Triage (we take turns).

Tensions were high. Meaning someone raised their voice once. No one had a chance to eat, let alone visit the rest room and they decided to remodel our break room so we had no place to retreat for even two minutes.

In the old days, the night would slow down after 2300. Not so these days. Up until I signed out at 0340 I was hanging blood and taking vitals.

I was so tired I wanted to cry but (1) it isn't professional (2) I didn't have the energy and (3) I was so dehydrated I didn't have any liquid to spare.

Why is it when I'm at home, I must urinate on demand but when I'm at work I have the bladder of a camel?

I asked a colleague in her mid-60s how she did it. When I leave work, I ache so bad and my back hurts so bad that I have to go home and take ibuprofen and a muscle relaxer so I can move.

She has so much energy and moves so fast - I marveled at her stamina.

Turns out she has to take the same meds I do.

Oh, so it isn't just me. But wait, she is 17 years older than me!

I have the same body as someone who is 65!

Waaaaaaa!

Ya know, sometimes ya just gotta whine.

Operation Grand Rounds

That guy in the middle row. Third from the right. He looks thrilled. Probably wants to be a skin guy and could care less about a gall bladder.

The guy in the same row, second from the left is so daft that the guys on either side of him have to explain what is happening.

But that was then and this is now.

Now we have operation Grand Rounds this week over at Cotournix's Science and Politics blog

But long before I knew him as "Cotournix", I knew him as just "Bora" from the Circadiana blog.

He gave Emergiblog its very first link.

Always wanted to express my appreciation.

Thanks Bora!

Dorothy Hamill and Andy Gibb = One Theraputic Relationship

Looks pretty reasonable to me.

Sit on your butt. Read a book with Lassie at your side, your feet on an ottoman and your wife cooking a big juicy porterhouse steak for dinner (hey, this was from the '50s, okay)

The text of this ad says that "physical activity is generally curtailed and overwork is avoided".

For some reason that is not the advice my doctor gave me for hypertension.

"....and the use of stimulants is restricted."

Okay, that makes sense...

Except that when I exhausted every means of research (my famous "I feel lucky" Google click), this medication is a vasodilator and a myocardial stimulant that lasts longer than caffeine.

Huh?

Oh, silly me....it also has phenobarbitol in it! I guess back then you could sedate your way to normotension.

I saw my doctor and all I got was a stupid diuretic and the advice to move more. And it works!

Without sedation.

Darn.

hhhhhhhhhhhhh

In my search for nursing/medical ephemera for the blog, I'm usually laughing my head off and mentally writing the story to go with it.

This one did not make me laugh.

I don't find much to laugh about where mental illness is concerned.

This medication is supposed to take someone on the edge of what I assume to be (schizophrenic?) psychosis and turn them into an attractive college co-ed.

Click on the image and try to read the print, it's small but you can make it out.

I worked for 2.5 years in a psychiatric unit and never saw anything like this ad portrays.

But it did bring back the memory of my psychiatric rotation in nursing school.

And a patient I will never forget.

hhhhhhhhhhhhh

We were both eighteen.

I was a first-year nursing student on my first day of psychiatric clinical. Melissa sat rocking in the corner in a chair in a psychiatric facility. I was supposed to pick a patient to be my "case" during the rotation.

"Why are you rocking?" I innocently inquired. Queen of theraputic interaction, that was me.

"It makes me feel better. You look like Dorothy Hamill."

In case you are wondering, I had been told that before. She was not hallucinating.

"Gee, thanks!" I replied.

Silence.

"Do you like music?" I asked. I had no clue what I was doing. We were the same age and I was so into music that my second choice for an occupation could easily have been "rock groupie".

"Yeah. I like Andy Gibb."

Oh....my.....god......that sealed the deal. This was my patient.

I was in love with Andy Gibb. So let's put it all together: same age, she thinks I look like someone I'd been trying to look like for a year, and she had the same taste in music.

I knew I would be comfortable with her as my patient. In retrospect, whose needs were being met here?

I asked her if she would allow me to be her "nurse" for the next six weeks and she agreed.

During that time we walked and talked. We worked on hairstyles and personal grooming. As we sat on the grass outside, she told me about her family and voices that came from nowhere. No, they never told her to hurt herself. They just told her that she wasn't very good. Or pretty. Just worthless.

"Why," I wondered aloud, "don't voices ever tell people that they are beautiful, smarter than the whole world and have the greatest hair on earth?"

We nearly split a gut laughing at that. I'm sure it wasn't the "theraputic" way of dealing with auditory hallucinations, but it really was funny. At the time.

She was very sick. Her diagnosis was "acute schizophrenia". I thought that because it was "acute" that it was curable. I had so much to learn.

The plan was for Melissa to go to a half-way house and she was going to be able to tour a few so we began making a list of what she would like in her new "home", what she would be looking for as she toured the various facilities.

The end of my six-week rotation was nearing and I had to prepare Melissa and myself for the fact that our relationship would be ending. I'm not sure who it was harder for, Melissa or me.

She cried. I managed to keep a professional facade and explain that while I was also unhappy, it was how things needed to be.

Melissa spent one more of our "rotations" at the psych facility, during which another student in my class took her case. Melissa asked about me every clinical day, but it was not appropriate for me to send any messages or to interfere with my student colleague's relationship with her client.

On the last day of our clinical, Melissa handed me a piece of paper. I was just walking out the door and I told her I would read it when I got home. She seemed happy with that and I left the facility for the last time.

It was a note thanking me for being her "nurse" and a request that I always remember her.

That's when I cried.

I have thought about Melissa often over the years. Where she is. How she is doing. Was she sad when Andy Gibb died? It is because of Melissa that I have always viewed psych patients as people who have a diagnosis, but are not a diagnosis. It is because of Melissa that I had over two wonderful years working with psych patients. It is because of Melissa that I realized psych nursing is the one place where just being yourself can be theraputic.

Melissa, wherever you are, I have always and will always remember you.

*************
Addendum: For those of you who are watching "Skating With the Stars" and see Dorothy Hamill every week, let me assure you that I am now the equivalent of 3 or 4 Dorothys and about the only thing we have in common is that she skated in the Olympics and I watched the Olympics....but I am dying to get that new haircut she has!

You're In the Pepsi Generation!

I knew it.

Nectar of the gods.

They used it to "force" fluids!

It was good for you.

JAMA said so in 1956!

Did they not know that it was full of caffeine and would cause a mild diuresis, precipitating a loss of fluid?


So freakin' what!

(I love this stuff. I live on the diet version. The folks at the local KFC and Taco Bell know me by name.)

I remember the days of the "force fluid" orders.

How on earth are you supposed to "force fluids"?

You can facilitate, encourage, offer, nag, hassle, guilt trip and threaten a giant intravenous line.

But you can't "force" fluids . Unless it's diet Pepsi. And the patient is me.

hhhhhhhhhhhhh

Here is a personal story about the wonderful concoction known as diet Pepsi.

Which, if I don't have it, qualifies as an emergency, hence the relevancy to Emergiblog.

I once paid a visit to my doctor for a mild headache that had lasted four days.

Nothing would take it away. Not Tylenol. Not ibuprofen. I'd wake up with it. I'd go to bed with it. Four days was long enough. I made an appointment.

So I give, precisely and in detail the "history of present illness" to the physician's assistant.

I emphasize that it has nothing to do with caffeine withdrawl. I have a constant caffeine level.

"Really?", she replied. "What is it you drink?"

"Oh lordy!", I said. I have at 44 ounce diet Pepsi in my hands at all times and I drink at least 2-3 cups of coffee a day. I usually pour 5-6 cups, but work gets busy and I don't have time to drink it."

"Do you drink any water?", she inquired.

I thought long and hard about this obviously complicated question before answering.

"No."

Turns out that my headache was due to dehydration secondary to drinking nothing but caffeineated beverages.

Oh geeze.

Now I am an all-or-nothing type gal, so I decided to test this hypothesis by cutting diet Pepsi cold turkey. None. Nada. (I knew I had to keep the coffee or I would have caffeine withdrawl.)

I began drinking water.

Lots of water.

Bottles and bottles of water.

I drank so much water that I was personally responsible for the San Francisco Bay dropping two inches. Ships had to re-route so they wouldn't get stuck in the Golden Gate.

The headaches stopped.

For six weeks I denied myself the caramel-colored-aspartame-loaded liquid gold with the beautiful sound of tiny carbonated bubbles bursting in their carbonated way.

I re-introduced the diet Pepsi slowly.

I now allow myself one large fountain diet Pepsi per day or one 20 oz bottle if I am at home.

I still drink water, but the shipping forcast for the Pacific region has returned to normal.

But, you ask, why not diet-caffeine-free Pepsi?

It tastes like Robitussin.

Disclaimer: I am in no way employed by or compensated by Pepsi Co. or any of its affiliates. I am, however, open to offers.

Lesson Learned

Medics have been called.

Except there weren't medics in the '50s, and this guy in white is injecting Methadone on scene.

The patient obviously didn't faint because he has the famous "head in crook of arm" sign. There is a police officer holding off the hordes in the background, but no sign of an MVA. And guy-in-white doesn't seem to be too concerned about C-spines. Good info on methadone in the ad, though.

But wait!

Massengill?

Don't they make douches?

A methadone douche?

Ladies, would YOU want to feel fresh as a daisy all day with a narcotic, anesthetic douche?

Doesn't that sort of, to put it gently, defeat the purpose?

You'd feel fresh all day but you'd be too stoned to care!

hhhhhhhhhhhhh

People often run into our emergency department in a panic, bringing with them a friend who is exhibiting an altered level of conciousness.

The patients are usually female, underage and intoxicated. The petite ones get carried in, others are placed in a wheelchair and are observed to be slumped over on arrival.

They arrive with a bevy of friends who were at the same function and are scared to death; so scared that someone has actually called the parents.

We make sure the airway is protected, do a tox screen to make sure that we are only dealing with ETOH, hydrate the patient and when they can ambulate, we discharge them and leave further "treatment" to the parents.

(It's a good time to give some education to the friends regarding alcohol consumption, too. They tend to be rather receptive when they are truly afraid a peer is dying.)

hhhhhhhhhhhhh

This time was different.

A gentleman informed the desk that he needed a wheelchair for his daughter, who was not feeling well. He had been called to come and get her from a party. I took the wheelchair out to the parking lot and the woman (she was in her early 20s) ambulated steadily to the chair. Hmmm....they don't usually do that.

She was slow but oriented to person and place, warm, dry and denied any medical problems. No allergies. Her vitals were OK, except for a slightly elevated respiratory rate. She was a bit "glassy-eyed", and occasionally I had to get her to look at me. The main thing was she took forever to answer a question and moved like an old VCR tape in slo-mo.

She also had a flat affect, just barely emoting enough to get angry when I asked her, for the third time, what drugs she was on. Or how much alcohol she had been drinking.

None.

"You are not acting normal," I said. "And I am concerned." That's when Dad broke in with this rather startling piece of information:

"She is drinking tons of water and Diet Pepsi and she always seems to be in the bathroom."

Oh no.....

I could have grabbed a finger-stick glucose level in triage but all of a sudden I knew what I was dealing with.

Hyperglycemia. New onset diabetic.

We grabbed a room, called the doc, took a finger-stick glucose that just read "High". As well it should; the actual lab glucose was over 1000.

Normal for our lab is around 70-110.

Had this patient been alone, without other people to notice her mental alteration, she would have gone into a diabetic coma. She would have died.

She didn't. We admitted her and she was discharged a few days later, with a life that had been radically altered in terms of lifestyle and responsibility for her own wellbeing.

I once watched a 25-year-old die of new-onset diabetes when I worked in ICU.

I felt abashed. For the arrogance of assuming her altered state was drugs or alcohol. For not believing her when she denied both. For not picking up on the elevated respiratory rate. For not getting an immediate fingerstick in triage on an "altered" patient.

For having to be reminded that in emergency nursing, no patient is "routine".

You Shake My Nerves and You Rattle My Brain - Emergiblog Goes Snarky

The year is 1956.

Your son is playing "cowboys and indians" with a bit of Daniel Boone thrown in. You have just completed vacuuming your entire one-story, one bathroom, formal dining room with the blond dinette set, three-bedroom tract home in the suburbs. You are sitting with a cup of coffee and reading the papers. You attended the local university for six months before receiving your Mrs. degree and have just read in the paper that Elvis may have a girlfriend. The highlight of your week is watching Bennett Cerf on "What's My Line" Sunday nights on CBS.

You just can't take it anymore!

You need Serpasil! By CIBA!

After exhaustive research (in other words, I googled it in one click), I discovered that it is an antihypertensive.

It is known generically as "reserpine".

I used to give it long ago in Coronary Care. I didn't get the connection until I read that it also works on "severe agitation in psychosis"!

Serpasil: for when the fifties weren't so nifty!

hhhhhhhhhhhhh

Caution! Uncharacteristic Snarky Post To Follow!

Seizures are extremely scary events to witness, be they due to pediatric fevers, not yet diagnosed brain tumors, head injuries, delirium tremens (DTs) or epilepsy. It is quite tramatic for not only the patient, but the family and witnesses as well.

They are pretty much impossible to fake. If you have ever seen one, you know what I mean.

But, in the ER, we occasionally have our share of amateurs actors and actresses who believe they can play the role well enough to win an Emmy for "Best Performance by an Actor or Actress in a Seizing Role in a Medical Drama Set in an ER".

And so...

In the interest of public service, I should like to make the following announcement:

You are not having a seizure if:

• You can call out, "Hey Nurse! I'm having a seizure!"

• You act like a member of the SpongeBob SquarePants Fan Club and
  

• "drop on the deck and flop like a fish" .
  

• Defined as: flipping your torso from side to side while lifting arms and legs three feet in the air and slamming them into the gurney.
  

• You miraculously avoid all potentially harmful surfaces (like siderails) while doing the above.

• You can speak full, coherent sentences with clear speech
  

• while doing the above

• including cussing out the staff who are trying to assist you in your distress.
  

• You place your head on your arms
  

• if your episode occurs on the floor
  

• you are less likely to get a headache that way.
  

• You only experience the above when certain significant people enter the room

• specifically law enforcement personnel of various agencies
  

• a member of the opposite sex who has decided that evening to release you from any obligations you may have had as a couple.

• Your parents, who have just found out you and marijuana have an ongoing relationship
  

• You immediately reach down to cover yourself when you realize your skirt is pulled up to your waist.
  

• This is not sexist as I live in near San Francisco.

• You can never assume who will be wearing what on any given day.
  

• You experience no post-ictal alteration of your consciousness level.

• You sit right up and marvel at how horrible your seizure experience was.

• And did we notice how your head went up and down on the pillow, like, twenty times.

Yes, as a matter of fact, we did notice!

And now that you are through with your performance and your trillion-dollar head CT that-had-to-be-done-to-cover-everyone's-derierre has been completed, here are your discharge instructions.

Remember, we're here to help you, twenty-four hours a day.

And don't worry about that trillion-dollar CT bill. The government will add the approximately $150 a month that they they take out of my paycheck to cover your medical bills and add it to everyone else's involuntary contributions so that you won't have to worry.

You're welcome.