« September 2008 | Main | November 2008 »

October 26, 2008

A Windy Day In Madison

I'm relaxing for my weekend off. I've been having a very quiet day.

Jess is in Chicago, she went to meet some friends who flew up from North Carolina to go to the Madonna concert. I wasn't invited, despite my passionate fan-duration that I have for the aging "icon," as Jess refers to her as. As it turns out, it was a good thing that Jess is in Chicago this weekend.

We both went there earlier this week. It's not a bad trip at all. To drive into Chicago might be a little stressful and irritating, but we simply drove to the little town of Harvard, IL, just over an hour from here, and then caught the commuter train into Chicago. Overall, the trip takes three hours, which is only a half hour more than if we drove (assuming that we would manage to miss the horrible traffic). We went there to drop off our visas for our China trip in December.

I assumed that the process of dropping off the applications would be difficult. The Chinese Consulate's website describes everything you must have in order to get a visa, including your hotel reservations in China as well as your travel documentation. So we went in a little worried, but we received a dismissive glance when we offered to show our plane tickets, and they never brought up the hotel reservations, which we don't have anyhow. Jess was particularly concerned about the fact that while she legally changed her name more than a year and a half ago when we got married, she hasn't been motivated to finish the process and get a new passport. So, we still have to buy her plane tickets under her maiden name. Don't ask me why she hasn't gotten a new passport, I have no earthly idea. At any rate, it made no difference to the girl at the visa counter. All she said was, "Pick up passport on Monday." Just like that.

So, fortunately, Jess had already made plans to be in Chicago over the weekend, she can get our passports. I don't know why I thought that they might send them back, since every other friendly consulate in the US would. I forget that the Chinese government doesn't like Americans, just our money as long as we don't send journalists or human rights advocates with it. Silly me.

Chicago was pretty great. We only had the day to walk around the center. I'd like to go back and spend the night during this assignment. I want to go to the jazz clubs and do some more social things than just walk around. November will be a good time to do that, since it will be too cold and windy to walk around the city anyhow, so staying indoors and in clubs will seem all that much better. Also, there is a great HI (Hostelling International) in Chicago. A HI is usually the best hostel around, and we stopped in at this one, it's right downtown, and it's very nice.

I would have to say that after NYC, Chicago seems a little smaller and less exciting. Of course, after we visit Hong Kong in December, NYC will probably seem like a boring backwater, too. Still, Chicago has plenty of attraction, it's a fun place to visit. I'm sure we'll be able to make the trip in the next month or so.

For myself, I'm just taking it easy today. Yesterday I went fishing. I'd gone last week and caught a ton of bass, more than 20. I went to the same exact hole, used the same exact lures, and didn't get single bite in several hours of biting cold wind. Last week had gotten me tempted to think that maybe the Loukonen Fishing Curse had been lifted. Again, silly me.

I found this advertisement, it's pretty funny. It's fitting for Madison, at any rate.

Until next time, be safe.

October 23, 2008

Suicidal Over JCAHO

It's that time of year again. No, not the holiday season. It is time for JCAHO (for Joint Commissions, pronounced J-Ko) to come rolling through the hospital. It seems wherever we go, JCAHO follows us. Maybe we are the harbingers of doom to hospitals in yet another way.

JCAHO is truly the blight of the medical system. They are actually a private organization, smiled upon by the government, which came up with a "provision that hospitals accredited by JCAH are "deemed" to be in compliance" back in the fifties. In essence, they are an accrediting organization that's been around for more than a century. Nowadays, they come through the hospitals, looking for the piddleliest little things to ding hospitals with. By ding, I mean bring multi-thousand dollar fines against. Each hospital apparently gets its own list of wrongdoings, there's no consistency that I've noticed. Here at the Swiss Cheese, one of their issues are saline syringes. Even though there is no needle involved, and even though we are talking about sterile saltwater, apparently these saline syringes are too dangerous to be left to the meddling hands of patients and their families. These people might try to squirt someone in the eye.

Another thing that they are tremendously focused on are two points on our admission paperwork: whether patients are suicidal and whether they want to quit smoking. Focused is not a strong enough term, they are downright anal about these two essential parts of patient care. I've had several conversations with the managers on my unit about making sure that these questions get filled out. It's hard for me to remember to complete these parts, because I'm noncompliant with making this an issue. Hey, if you want to smoke, go ahead, it keeps jobs available for me when you get lung cancer. And suicide? Don't get me started on why people seem to be so unsuccessful with that.

Anyhow, there was a false alarm on Monday. Word gets out when JCAHO is in the house, meaning they are somewhere in the hospital making some employees miserable (and suicidal), while at the same time interrupting the much less important patient care. It's been rumored since we arrived in August that JCAHO was coming, so there has been this palpable tension building everywhere, as managers throughout the hospital develop hypertension and stress ulcers. Well, word came that the dreaded JCAHO goons were finally in house. That set off a frenzy of action, none of it remotely involved with patient care.

Of course, I was taking care of a patient who had been admitted over the weekend completely unresponsive. A spur of the moment decision to get a CT scan turned out to be very helpful, it showed that he'd had a horrific stroke, and one side of his brain was completely whited out. That explained why he didn't follow any commands at least. At any rate, the opportunity to ask him if he was ready to give up smoking or if he was suicidal never arose for me, on the three days I cared for him. I could have asked his family, but they never showed up. Unfortunately, the fact that I hadn't asked him those two essential questions meant that I had to face the manager.

It wasn't that she showed up to talk to me, after not even saying hello for weeks, just to point out that these two questions were incomplete on the admission form. It was plain enough to her when she saw the patient why I couldn't just ask him. It wasn't even that obviously this man had smoked his last cigarette, and that he was already on a different train to the afterlife. It was that she wanted me to call his family to ask them whether this man was suicidal or ready to quit smoking.

That's what really stunned me.

I'm getting good at my poker face, I've been working on it a lot here. In my head, I was heaping scorn onto her head like hot coals. I had all sorts of witty comments which I silently rebuked her with. But outwardly I was cool as Wisconsin nowadays, and put forth my best lie.

"I'll get right on it."

Later she sent the charge nurse to remind me that these questions still were unanswered. The poor girl was almost too sheepish to tell me, so I was nice to her. I didn't tell her that there was absolutely no way that I would stoop to such levels to follow such stupidity. Can you imagine that conversation?

"Hello. This is Bob's nurse. I am so sorry about the news about his stroke. But listen, I have a question for you. Do you think he is ready to give up smoking? How about suicide? Has he talked about wanting to kill himself recently?"

If she wants those questions answered, she'll just have to use the phone in her office to give that family a call.

That is what JCAHO does for our medical system, a private organization operating with government approval to hold hospitals hostage under the threat of massive fines for such total, complete pig patooey. No wonder we pay more per capita for our healthcare than any other country and yet so many get so little from it. 'Cause, God forbid someone steal some saline syringes, we need a massive organization to keep an eye on that.

Until next time, be safe.

The Wisconsin Pictures Are Up

Holy crap.

It has taken me all day, but I have finally gotten myself caught up with posting pictures onto my photo website. Fortunately, it was a cold and windy day out there.

I ended up posting 13 different galleries, covering two full months. Now, I can see everyone's eyes begin to glaze over just at the thought of that. Well, never fear. I have a suggestion.

I won't suggest that you don't look at all the pictures. No, I've worked too hard for that, my fingers are nearly bleeding from my exertion. Look at the time this entry posts, it really is that early in the morning. Instead, I would suggest a schedule.

Every time you feel your eyelids begin to droop as you look through these photos, you should go get a cup of coffee or something. You must pace yourself, after all, you have 13 galleries to look through.

Honestly, there aren't that many pictures. And they are all interesting, obviously. Here is the link to the main Wisconsin Assignment category page.

Also, I've posted a page I called "On Assignment." While that title isn't so original, I would urge you to look again at what time I am posting this. What is original about this page is that it has all of the postings that I have put up since we started travel nursing. Even better, the newest ones are first, so you won't have to go to the bottom to find a new posting. You'll be able to access this page right from the link above my picture to the right. What could be better?

Get lookin', folks, there are a lot of pictures to peruse through.

Until next time, be safe.

October 17, 2008

One Last Photo Gallery From NYC

I've been a little lax on my photos. It's not that I haven't been taking any photos, I've been shooting pictures as prodigiously as usual. On the other hand, I've been downright lazy about posting them on my website.

In my defense, there are a couple of reasons. First, I having worked any night shifts except for a short run of them a couple of weeks ago. Night shifts are when I get the most done with my website. Things are so much slower I have time to actually concentrate on the time-consuming process of building these pages.

Also, the weather has been quite nice here so far in Madison. It's hard to sit around the house on the computer when I could be outside, fishing or hiking or even taking more photos. I figure it's going to be getting really cold here in by the end of the month, so it will be much easier to condone spending a day off working on my website.

Never fear, though, I have nine galleries of Wisconsin ready to be built, and there are several more that I still need to go through the photos to select which ones to post. In the meantime, I've finished the last gallery from our assignment in New England. This one is from our visit to NYC, when we spent the night in a hostel and had a great time. I'll have the other ones up as soon as I can get to them.

NYC Pictures
Overnight Trip In NYC

Until next time, be safe.

Neuro On My Mind

After we finished our assignment at the Y, the plan was to go to work up at Dartmouth in New Hampshire. Seeing that we ended up in Wisconsin, obviously that didn't work out as expected. A large part of why that didn't work out was because I had very little Neuro ICU experience. At the Big D, the only neuro issues I encountered were the crazy crackheads, and I didn't see any more neuro at the Y. So, while it was true that I didn't have true neuro experience, it wasn't my fault.

Well, working here at the Swiss Cheese has changed that.

The most obvious difference between the unit that I work at here in Wisconsin and all of my previous experience is that this is a trauma unit. Then there is the fact that this is Wisconsin, the state of flaccid attention to the relationship between motor vehicles on the melons that sit on our shoulders. Wisconsin has an odd oxymoron, emphasis on the last part of that word. People here have survived for the most part because of a governmental acceptance of lack of common sense.

See, in New York City, where there are multitudes more people and hence more vehicles, people tend to be very careful walking or biking in the road. This is because there is no law that gives pedestrians the apparent complete right of safe passage. I'm guessing that the officials in New York City assume that if you walk out into traffic and don't look, then it's your own fault that you get creamed by a bus. Ask me, I got a closer look than comfortable at the front of a bus there.

People don't have the same respect here. They assume that if they walk out in front of you, then you will be courteous enough to stop. Fair enough when the person driving sees them and has time to stop, but poor decision making at night when they are wearing dark clothing. Or when they are walking in the middle of the lane on a windy country highway. Or any number of other instances when it's just plain dumb to walk out into traffic. I've had to start taking a different route home from work, away from the university and its students, who apparently aren't enlightened enough to stay out of traffic.

Then there are the two-wheelers, a subject I've touched on before. There is a huge culture of mopeds and motorcycles here, followed by a huge culture of ignoring the obvious fact that the skull is poor protection against the hard concrete of the road at any speed. I've been going down the main drag in Madison at 6:30 am, to see a moped weaving amongst traffic, driven by some young girl with no helmet on. Am I supposed to feel badly for them when they show up a hour later in the ICU with a big, fat, swollen head?

It all pretty much stupefies me. There apparently is a sense of entitlement here, government sanctioned to boot, that has people thinking that it is ok to not protect their own lives on the road with cars. To me, it's a no-brainer; I'll pass on the sense of entitlement and stay alive, because when people get hit, they may have been protected by the law, but it didn't do much to protect their bodies. The person at the wheel of the car might be at fault according to this state's law, but all they get is a dent in their hood. Crazy.

Rant aside, my point is that my unit gets a lot of neuro patients. There is a neuro ICU in the hospital, but often these guys come in with all sorts of traumatic injuries, and neuro takes a backseat to the medical aspect of their care. After all, what use is the head when their body is dead? It sucks for these folks, but it has worked out pretty good for me, because I'm lapping up the neuro experience like there's no tomorrow.

This week has been particularly useful to me. I guess before on the rare occasion that I actually had a neuro patient (like the time that I got floated to the neuro ICU), I've just pretty much gone through the motions of doing the neuro checks and whatnot. Mostly, that means I look at the charting that the nurse before me did, then go do an exam that covers all of the checks that they'd done. Well, this week has been all about practice. Almost all of my patients have had some degree of brain injuries.

Two of them have had craniotomies, which is where they've taken out a piece of the skull to relieve pressure in the head, leaving the bone out until the swelling has resolved. This means that these two patients had an area of their head where there was no skull. Of course I had to feel that area, push on it a little bit. Yes, yes, softly! Geez. That was pretty interesting. I had to do my bi-hourly neuro checks, so I actually learned how to do them, and what to look for. A couple of my patients were really banged up, so I got some trauma mixed in there, with some fancy terminology to toss out at unsuspecting interns and new nurses. Even better, I had not one but two ventriculostomies, one each for Monday and Tuesday.

Essentially, these are drains that help decompress the pressure in the skull. They are the first line in surgical defense to do so, meaning that the person will require a craniotomy if it doesn't work. They are also a monitoring device, allowing us to measure the ICP, the intracranial pressure. They're fairly easy to deal with once you've become accustomed to them, but there are a lot of rules and stipulations that are involved, as well as measurements I'd never heard of before. Of course, I acted real nonchalant about it, using the classic traveler line: "Oh, I've never used the equipment this hospital uses. Do you mind running me through the equipment?" Hey, it beats sneaking off to look it all up on Google after report. Not to say I didn't do that too.

One of the big issues that Dartmouth had pointed out with my application is that I hadn't ever had a patient with a ventriculostomy. Well, the skills checklist has been updated, and I continue to heap scorn on the dungpile that is Dartmouth.

Oh, get this. One of my patients was a biker dude, you could tell by the cattleyard's worth of leather when his family came in. This guy will probably be sucking his meals through a straw the rest of his life, but guess what was on the cover of the guest book his family brought in for friends to write condolences? A big, chrome Harley, no helmet in sight. I didn't get upset, he had a ventric. Sweet!

My other ventric was a kid in his late teens who was doing some wicked trick on a skateboard and didn't make the landing quite right. I mean, he made the landing, but on his head. I guess having four wheels under you doesn't mean you shouldn't wear a helmet. Seriously, if he'd been protecting his melon, he would have had a stiff neck and a skinned elbow.

Anyhow, it was quite an educational two days for me. I even got floated for eight hours to the Burn Unit, which was crazy. They'd just gotten a fresh burn in when I arrived, which was fairly gruesome. It was very interesting to see, though, and I stepped right in to get involved. They even loaned me a pair of the unit scrubs to wear, so I looked like I was one of the group. My single patient wasn't a burn patient, but was instead, of course, a neuro patient.

Until next time, be safe.

October 06, 2008

Night Shifts At The Swiss Cheese

I just finished four night shifts in a row. They were the first night shifts I've worked at this hospital, and possibly the last. I didn't see any night shifts on the upcoming tentative schedule, although the tentative schedule might just be that and change.

The first night was a little rough. Since I haven't stayed up all night (or really past 1 am) since leaving Connecticut, it took me a little to get used to it. That was the hardest 3 AM that I have had in a long time. The next night was easier, my body had gotten back into the late night routine.

I fell in with the night crew pretty easily. By nature, night shift folks tend to be fairly independent, dark in humor (bordering on obscene), and fairly judgmental and grumpy, at least until they have gotten a chance to know you. Coming into a unit and getting people to trust you is a different process for day shift and night shift. A lot of day shift folks tend to be Type A personalities, meaning that they are very much about doing procedures just like the nursing manuals tell you how to. I tend to think that these people are so rigid in the proper procedure because they literally have an audience--they have the doctors, the families, the management, and here in the Trauma Unit at the Swiss Cheese, the eICU Big Brother cameras monitoring their every move. It creates a feeling of paranoia, having so many observers, so it's little wonder that they do things by the book, even by the paragraph, the sentence, the letter.

On the other hand, in order to get the night shift people to trust you, it is a little more straightforward. You just have to demonstrate that you are capable of handling yourself, that you can do your thing without having to get help every five minutes. Again, there is a strong sense of independence on night shift, the lights come down, the doctors scurry off to their holes, the families (hopefully) drift off to sleep in the waiting room, and management, well, they aren't there and that is what really matters. So, you need to demonstrate that you can get all your work done, walk around to ask if anyone needs any help, and still spend at least fifteen minutes of every hour reading CNN news. Then the night shift people trust you.

It was actually unexpectedly busy this last weekend. There was a big university home game on Saturday, meaning there were throngs of drunken students everywhere, so we had some MVAs (motor vehicle accidents), some car surfers, lots of lacs (lacerations), and a fair amount of blood and broken limbs. Then there was an alcoholic who was going through withdrawals, and the best way to get people to like you is to step in with your cuffs rolled up and say, "Hey, if there's a type of patient I can handle, it is these drunks." I guess my time in Connecticut at the Y didn't go to waste, for they gave me at least one drunk per shift. At least one.

And this guy was a cherry. He was literally drowning in secretions, could barely breath much less talk, but that didn't stop him from using his last few breaths to call us f-ing $@%@% and @$@%## and @%%##%. He could barely summon the strength to inhale, but he could still pinch and punch and even try to bite my finger. I've said it a million times, but Propofol (and ET tubes) are proof that God loves us (that, and beer, of course, but that's proof more that God wants us to be happy).

Good times.

In more exciting news, I just purchased tickets to China for December. We are flying to Hong Kong on December 4, will spend a few days on the island, then hopefully spend a little more than a week in mainland China before flying back to the States on the 18th. That depends on our success in getting visas, but luck has it that we are a two and a half hour drive from the Chinese consulate in Chicago, so with another $260, we should be good to go. I managed to get the tickets for $1100 after taxes and fees, which I find to be quite a deal, especially given that tickets for identical dates to Sydney, Australia, are going for $1500 (recently down from $2000).

Anyone want to backpack in China for two weeks? It's gonna be fun.

Until next time, be safe.

October 01, 2008

My Birthday Weekend

I'm now officially in my thirties, I've left behind my days as a twenty-something. I was expecting for a more severe reaction to such a change in my status, but that didn't really come to pass. Perhaps it just hasn't hit me yet. Maybe the expected depression might still hit.

At any rate, I had a good weekend celebrating my birthday. As I mentioned earlier, I was fortunate to get five days off. I've taken full advantage of them, and have used them to get to know this area better.

Fall is rapidly approaching here. The leaves are only starting to change, but the weather has dramatically become different. Yesterday, the highest temperature never broke 60 degrees, and today is looking to be even cooler. I've been told by a native Wisconsonian that there may be another period of warm days, the so-called "Indian Summer," but besides that period I can expect mostly cold weather, perhaps even snow by October. I was really hoping that there would be warm weather further into the fall. I'm hoping the expert advice is very wrong.

Anyhow, as fall has certainly arrived, there have been quite a few festivals in the area. We took advantage of a couple of them last weekend. Jess and I went with a couple of other travel nurses to the Cranberry Festival. Strange as it may sound, I actually thought it could be fun. I envisioned tours through cranberry bogs, lots of cranberry related foods, fall games, that sort of thing. After all, I believe that Wisconsin is actually the largest or second largest producer of cranberries. So the four of us made the hour and a half drive up to the little town of Warrens, WI, on a crisp and slightly overcast fall morning. Right away, I started getting a bad feeling about it. The festival itself was obvious, with crowds streaming towards streets lined with stalls. After the first fifteen minutes of browsing, it became suddenly obvious to me that this was no cranberry-related festival. There were few if any items at all that were related to the fruit. I realized that we'd come instead to an arts and crap, er, crafts market. It might have been very large, strewn down several streets and crowded with thousands of people, but it was still arts and crafts. And I have an intuitive dislike of arts and crafts.

Then we came upon the food section, where there were vendors of all sorts of crafty foods, like meat jerky, cheeses, sauces, dips, and so on. Hey, if I'm going to be at a craft fair, I might as well enjoy it, so I descended onto the samplers like a vulture to a pancake squirrel. The tables were all handily side by side, so I just continued down the line, sampling every food item set out. There is a fine balance to it, for the vendors are wary of folks who feed but don't buy, like myself. So I had to wear an expression of torn indecision, as though I was trying to decide just which jerky or cheese or sauce I would spend my money on. This actually allowed me to resample some items, as though to make a final comparison before dishing out my money. By the time we arrived in the nut tent, though, I couldn't keep up the ruse, and scarfed down nuts of all sorts like they were going out of style. This didn't go well, as the vendor started following me as I began a second round of the tent. I stood under her gaze, pondering at the contents of one of the bags of cracker mixes before I finally fled. By then I was stuffed. I didn't even need lunch.

As tedious as being a cranfester was, it was fun to be outside on a nice fall day, and to hang out with some other travelers. Later, after returning to Madison we went to a late show at a local comedy club downtown, the Comedy Club On State. There were four comedians, culminating with a comedian from Las Vegas. It was a hilarious show, and my face hurt by the time we left. I feel like we haven't taken full advantage of Madison's downtown, since we are a good twenty-five minutes of driving from there, so it was fun to go to the show, and then stay out until 2 am.

Sunday we went to another festival, the much more promising New Glarus Octoberfest. New Glarus is actually a charming little town south of Madison, home to the New Glarus Brewing Company, which has been one of our favorite breweries up this way. They pretty much hosted the festival, so obviously there was good Octoberfest beer to be had, as well as brats, polka music, and beer-cheese fondue, melted in a big vat right at the festival and served free over bread to everyone around. It was quite excellent. New Glarus itself is a very nice town. Apparently it was settled by Swiss immigrants and retains that style of buildings, but in an authentic way and not the nauseating reproduced fashion that you mostly see in the US. We plan on visiting the town this fall just to see it without the festival, in all of its fall colors.

Monday, I had the day to myself, which I spent fishing, a story I wrote about in a blog entry that day, no point recounting the lack of success I had. Yesterday, my birthday, Jess and I went out to Spring Green, a little town west of Madison. It was the town that Frank Lloyd Wright built his summer home in, the Taliesin House. She took me there to go on a guided tour, which turned out to be more interesting than one might think. I knew nothing about Frank Lloyd Wright, other than the fact that he is America's most celebrated architect and that he had a complicated personal life, which I gathered from hearing about the book Jess just read, Loving Frank. Apparently, at this same house, his mistress, her two kids, and four other people were axed and then burned, along with part of the house, by a crazed employee. That made the tour more intriguing to me. We didn't get to see the chalkmark outlines where the bodies were found, though, the tour was focused instead on the creative juices and architectural wonders that came Mr. Wright and that house, which was rebuilt and served as his retreat. As little as I knew about his work, the tour was interesting, and I took a lot of pictures of his house, which was pretty amazing.

Finally, last night, we went out for sushi with a couple of other travel nurses, then out for drinks in the bar conveniently walking distance from our apartments. There are pool tables, shuffleboards, air hockey tables, and several other games, all of which we played until we closed the place. Which is to say, it was a nice finish to my birthday weekend.

Until next time, be safe.

Hosting by Yahoo!