Halloween

Friday

"Pirates of The Carribean"
Me, Pat, Karen, Karin, Kathy

I love Halloween. I guess it's because it's this time of year that I feel comfortable in going all costume designer and exposing my inner actress and artist  to the world (or at the very least, my friends and family). For me, the Halloween season usually begins around the last week of September. Costume creation and/or theme planning is normally right up there on my priority list and I love it.

Not only do I like putting together costumes for myself,  but I get a kick out of creating something fun for others as well. Buying or renting a costume would take all of the fun out of it for me.

This Halloween, I will be in the hospital, working. I'm thinking that being approached by Cruella DeVille (or Snow White, for that matter) with a syringe in her hand as you’re connected to life support … loses it’s appeal for many. So I'll look forward to appreciating all the little ghouls and goblins that will come to my door for treats instead.

A few costumes from my collection have included…
  • Witch (a given...)
  • Geisha
  • Flapper
  • Snow Queen
  • Tippi Hedren in “The Birds” : blond wig, Chanel suit, dainty handbag
  • Star Trek alumni (Spock’s sister)
  • Zulu Warrior (one of 4 other tribe members)
  • Minnie Mouse
  • Dorothy - The Wizard of Oz
  • The Blues Brothers (I was Jake and Doug was Elwood) – a real crowd pleaser - Does anybody out there have a picture of us in this costume? Debbie? I don't have one.
  • Pirates of the Caribbean (one of 5 pirates – Girls Trip Bahamas 2008)
  • Little Red Riding Hood & The Big Bad Wolf
  • The Mario Brothers
  • Survivors of 'The Titanic' 

Medic & Minnie (Terry)
Zulu Tribe
Donna, Mo, Me, Eileen
Spock's Sister with  Lance & Catherine
Big Bad Wolf (disguised as Grandma) and Little Red Riding Hood
Cardiac Nurses in disguise - sometimes less is more.
Jag, Me, Peggy
Flapper, Witch, Geisha
Bobbie, Me, Jag
First Class Passengers of The Titanic

The Dog Wash: A Photo Essay

Tuesday

Like many dogs,
Duke loves to ride
in the car.

Suspicious of the
final destination, perhaps?...


Vet?
Daycare?
Dogwash?
"Nooooo!"
"Oh, The Humanity!"

Apparently, Duke's memory of his
 traumatic experience was short-lived.

Five GSW's

Monday

It was about 5 am and the drama had died down in Surgery ER. Most all of our patients were in the OR, the ICU, transferred to an in house bed or were *OTD.

We were pretty well ‘done in’ and several of us had been sitting on stretchers, when the overhead page came from triage… “Surgery... Five *GSW’s on the dock.”

Hopping off our stretchers and steering them towards the front loading dock, we found five, well dressed women wailing in pain and anxiety, who had been shot multiple times and literally dumped at our front door.

Each nurse scooped up a patient and snagged a *PCA, intern and/or medical student. We headed for an available trauma room and got busy.

My patient was agitated and howling so loudly that any attempts to calm her fell on deaf ears. Ours. Her loud and incessant wail was heard throughout Trauma Hall. Calming her was necessary in order to deliver good trauma care and to improve her outcome but it was more important to do what we were trained to do. Oxygen, IV’s, monitoring and diagnostic studies were initiated. Exposing every square inch of her body was necessary to determine any unknown wounds or injuries.

It was at about that time that I learned my hysterical patient was going to be alright. I also learned that ‘she’ was actually ‘he’ and I was surprised to notice how my approach to calming ‘him’ was markedly different than how I attempted to calm ‘her’. Food for thought.

Word travels fast down Trauma Hall and the same discovery was being made at about the same time in each of the five trauma rooms.

Luckily, all five GSW’s were not mortally wounded and would be OK. Unluckily, their wives were on their way to the ER and our patients were getting a little nervous.

__________________________________________________________

*OTD - Out the Door
*GSW - Gun Shot Wound
*PCA - Patient Care Assistant
__________________________________________________________

Parkland 7: Surgery ER Orientation

Thursday


Parkland’s ‘Surgery Pit’ was divided into three separate hallways, each hall had an assigned RN and each hallway wound up connecting to one long corridor that we unimaginatively named "Front Hall". Front Hall was where it all happened. Two Unit Clerks (secretaries) ran the show along with the assistance of the Pit Boss, assigned RN's and everybody else.

I learned early on that Parkland's Unit Clerks could make you or break you and it was in your (and your patient's) best interest if you communicated clearly and respectfully with them. The amount of information that they processed simultaneously was awe-inspiring and they 'set the tone' for your shift. Unit clerks were responsible for tracking down doctors, nurses, interns, respiratory therapists, housekeeping and who-knows-else all while having to answer the telephones that rang incessantly, patient call lights, placing "stat" Dr's orders, dealing with irate, drunk or stoned patients and/or family members, calling radiology, lab, blood bank ...and the list goes on. Only the best Unit Clerks worked Surgery Pit.

Surgery ER Orientation:
  • Trauma Hall: Had about nine fully equipped trauma rooms - one of which was outfitted for both pediatric and adult trauma. At the end of Trauma Hall, a door would lead to the Helipad. The patients who were triaged to Trauma Hall were in critical condition or had a very high likelihood of deteriorating rapidly. Many of our patients were in Trauma Hall as the result of Motor Vehicle Crashes, Penetrating Trauma (Stab, Gunshot wounds) and Burns. Trauma 1 was a room reserved for only the worst case scenarios. It was where John F. Kennedy was cared for.

  • B Hall: About 10 rooms designated for high acuity surgical cases

  • C Hall: About 10 rooms for low acuity surgical cases
    [my room numbers may be 'off'' ... as my memory can be 'fuzzy']

  • Front Hall: Unofficial stretcher spaces along the front corridor of Surgery. Usually reserved for 'stable' people who had been stabbed in the chest (and the like) and were scheduled to have repeated chest xrays in six hours. If their condition had not worsened - they would be discharged. Parking these patients in the hall would "free up" exam rooms for others.
Front Hall was the place where docs, RNs, medical students, secretaries. PCA's and whomever else might be hanging their hat in Surgery Pit on that particular shift would congregate. A good PCA (Patient Care Assistant) was worth their weight in gold. They were an integral part of the team effort and I don't think I ever told them just how much they were valued. Just thought I'd mention that.

One night when we were running full tilt. I was the assigned “Trauma Hall" nurse. And then, "The Bus Let Out” (a familiar phrase used when we suddenly got an onslaught of patients). Our trauma rooms were filled simultaneously.

Fatigue-wearing. healthy-looking people showed up looking like they were ready to work in the trauma rooms, I took advantage of their presence...“splint this, apply pressure here, draw a ‘crit’for me, watch this guy, take vital signs, bag him…” They understood my language and seemed to know what to do. It wasn’t until around 4 am that I thought to ask one of them, “So, who are you guys anyway?” They were medics in training with The National Guard.

My last night shift in Surgery ER was like any other. Sick and injured people. A lot of them. Counting was just not done - no time - our mission was to keep our heads above water, stay alert for any clinical changes in our patients' condition and to be prepared for what might hit the door next.

He was a tall African American man in dark clothing and in obvious distress - pale, leaning forward, clutching his abdomen, his staggered gait forebode impending collapse - an acute abdomen, to be sure. Swinging out of C-Hall, I spotted this man who apparently knew exactly where he needed to be - as he had bypassed triage and security to present himself to our Surgery Pit.
"Sir! How long have you been in pain???" I hollered out as I rushed towards him in order to get him on the nearest stretcher. His response was somewhat terse... "Ever since I got shot!".

Ahhh. Parkland.



Parkland 8: OB-Gyn

Friendship

Wednesday

I am so fortunate to have a friend like no other.

I remember reading somewhere that ‘people look for qualities in their friends that they may be lacking in themselves’. Although I don’t consider myself to be a royal witch on wheels... I tend to agree.

She has 'been there' for me in good times and bad for over 15 years. She is kind, thoughtful, loyal and patient and she has taught me more than she will ever know and I consider her my sister.

Kathy's Lessons...
  • Doctors are much more easy to get along with if you feed them first.
  • Laughing at yourself, is the first step to getting over yourself.
  • When you get up to go to work at 5am - Eat lunch by noon.
  • Be friendly and nice to everyone you meet.
  • Wearing high heels takes a lot of practice.
  • Hip-waders can be fun.
  • A ‘thong’ goes a long way to hide panty lines.
  • Always be gracious and grateful.
  • Loyalty is paramount.
  • Sharing is good.
  • Patience.
  • A compliment goes a long way in getting out of an uncomfortable situation.
  • Family, Friends and Pets are most important in life.
  • Energy drinks and vodka were created for people like me.
  • If the choice is "sparkly vs. not sparkly" - always choose "sparkly".
  • Sleep is for sissies.
  • Never pass up an opportunity to fish.
  • It's nine o'clock somewhere.

Thank you for being a wonderful friend.

___________________________________________________

Yesterday I learned how to add a “Fan” box to my blog! Now, I just need ‘fans’. Can ya help a girl out?

Wanted: Friends to pose as fans of “It’s Always Something…”

Just go to
http://www.joanyspot.blogspot.com/ and click on the “Become a Fan” box on the right margin of the page.

I realize that an outright solicitation of a fan base may seem a little…pushy but just look at that box –“Joan Young Spotswood has 0 fans” – it’s painful.

Parkland 6: Pedi ER (Part Two)

Monday

Lesson in Humanity

It was as busy as every other night in Parkland's Pedi ER and we were (yet again) overworked, overstressed and coping when along came Rhonda and her 2 year old son. These two were “Frequent Flyers”.

“Frequent Flyers” were people who were well known to several ER staff. Despite having to wait for hours to be seen for a minor chief complaint, the frequent flyer would hang in there and be treated for “God-knows-what.” Generally, their complaint of the day was not even close to being an emergency but they perceived any minor ache, sprain or pain as life threatening. When the minor ache, sprain or pain was involving their child – it was frequently magnified beyond reason.

When the discharge instructions were something along the lines of …”Go home, he has a virus, give him Tylenol for fever and have him drink plenty of fluids.” It was usually met with disdain as they were expecting a leukemia (or worse) diagnosis and they had “waited all this time for that?” You got me. I thought they would have been happy that Little Johnny wasn’t going to die but …

While I’m on this topic … It really miffed me when a parent would respond to my instructions to administer Tylenol for fever with... “I can’t afford it” yet they would be carrying cigarettes with them. They expected and would demand a prescription for Tylenol. Medicaid would pay for it. Over time, I just realized that I wasn't going to change them and I got over it.

You may think I sound disconnected, callous and arrogant. I was. Detaching myself from the human condition and its vulnerabilities was an effective way to cope with the incredible numbers of needy people. It worked. For a while.

On this particular night in Pedi ER, Rhonda and her son had been seen by the doc. I casually walked in to give her the same discharge instructions she had received time after time again. As I read the instructions to her, not making eye contact and caring less for her and her son than the kids who were “really sick”, I added, “follow up with the Pediatric Clinic at Children’s Hospital tomorrow morning”. Rhonda burst into tears.

In a lapse of arrogance, I looked into her tear filled, mascara smeared eyes and asked her why she was crying. "I work at night and sleep in the daytime" she said. It was apparent to me that she was little more than a child herself. I asked her how old she was…”17” she said and then the floodgates opened. Rhonda unfolded the story of her life. It sounded like a bad movie plot... pregnant at 14, kicked out of her parents house, met a guy who took care of her, turning tricks for a living, trying to be a good mother.

Listening to her, it came to me that her visits to the ER at night were a respite from her life. She didn’t have to “work” and she and her son were safe and relatively comfortable in our overcrowded Pedi ER.

Was the story for real? Who knows? I've been told a lot of stories. But on that night I made the conscious decision to look into my patient's eyes again.

What have I seen? A lot people choose the ER as a respite from their lives.

Parkland 7: Surgery Orientation

Parkland 5: Pedi ER (Part One)

Friday

Many moons ago, Children’s Medical Center in Dallas did not have an ER. They did have a clinic that was open during business hours, however. That meant that Parkland’s ER would always take Pediatric Trauma and it would manage all other Pediatric Emergencies daily from 4pm until 8am and 24 hours/day on weekends.


For a nurse with one year of ER experience, Pedi ER was scary but remains as one of the best clinical experiences I have ever had.

Opening daily at 3pm with two RN’s, a Patient Care Assistant (PCA) and a Pediatric Resident, we would prepare for the onslaught of sick children and anxious parents.

The gauntlet of waiting parents and kids sitting on the floor of the long hallway leading up to Peds was daunting. We didn’t have a lot of treatment rooms, so kids with asthma would be corralled into one room, sat side-by-side on two stretchers and hooked up to nebulizer treatments in hopes of an improvement in their condition.

Depending upon the chief complaint, children were seen as quickly as possible. We became expert in a 30 second pediatric assessment - check vital signs, listen to lungs and determine if the kid looked ‘good’ or ‘bad’. That was about it. Documentation was minimal. Starting IV’s and drawing blood even from the tiniest infant was common practice. Infusion pumps were rare back then, so we resorted to the use of controlled fluid administration via a device called a Buretrol that would allow only a specific amount of fluid to be administered – they ‘went dry’ a lot. Pulse Oximetry had not been invented yet (eeek) and our resident would obtain urine specimens by manually withdrawing urine from baby’s bladders via a needle and syringe.

Any Pediatric Trauma patient would be triaged to the Surgery Pit, not Pedi ER. Thank God.

Children that looked ‘bad’ (or worse) would be placed in one of two resuscitation rooms. One RN, a PCA and the doc would work the situation. The other RN would have to manage the rest of the Pedi ER. We would frequently have kids that “looked bad.”
Enough said.

Pedi ER was (at best) nightmarish from about 6pm until 2 am. Compounding an already stressed department with not only the numbers of sick children but also with the persistent crying, overcrowding and rising anxiety level of exhausted parents.


I loved it.

Parkland 6: Pedi ER - Part 2

Paranoid in South America

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