Monday, April 7, 2008

Human Balloon

It was one WILD weekend at work. We weren't totally full, but the patients we did have were sick enough to require a little extra care than our usual acuity patients do.

There really wasn't such a thing as a "good" assignment of patients this weekend. Not for the nurses or for us aides. If it wasn't a patient having frequent bathroom trips, it was confrontational family members or vomiting episodes.

However, there was one group of patients that was universally considered a really demanding assignment. And guess where I was Saturday? Yup, with that group.

The highlight of this group was a man whom I will call the Human Balloon. He had a unique condition, subcutaneous air (air under the skin). He literally looked like someone had inflated him. His face was all puffed out, his eyes were swollen shut because of the air under his eyelids, his hands and feet were puffed up; this guy had air all over the place. Actually he kinda looked like this:

Yes, I know I'm bad! But he looked a LOT like that (only with a midline incision on his chest from his CABG and 2 chest tubes). He actually would have been a cool patient to take care of except for the fact that he was a total dickhead.

I don't know if he was actually mentally challenged or just stupid, but this man would NOT listen to any instructions you gave him. You'd say "okay, step to your right towards the chair", and he'd go to the left and not listen when you'd say "okay....your other right". The nurse and I would literally have to shove this guy around to keep him from falling on his ass. But he could hear, definitely, because the second you said he had to get out of bed he'd throw a hissy fit. Then, the second you left him alone sitting in his chair, all fluffed up with his breakfast right in front of him, he'd throw said breakfast to the floor and immediately stand up and go into the hall, disconnecting his chest tubes in the damn process. Anyway, he was a trip and so was his family, but I persevered.

Then there was the very heavy lady who needed a lot of physical assistance to move around, the bedridden pooper, and the little old lady who was lonely and wouldn't stop talking long enough for you to gracefully leave the room. Now, I understand that none of these people could really help it and weren't doing it just to make my day bad, but all of them together made for a really busy day and left me wishing I could have done more for them, especially the lonely old lady. I hate days where I go home thinking of all the things I could have done if only I'd had more time, which is why I got out of Long-Term Care.

Requested a different group for Sunday (we're rotating this bad group around to different people), and the day was a ton better. Not nearly as soul-destroying and I got to do a lot of extra care on a lady who needed it.

The Human Balloon went to the ICU Sunday morning - apparently his respiratory issues got the best of him and he had to be intubated. I do genuinely hope he's okay, even after all the crap he put me through on Saturday. The ICU is probably the best place for him really, where he can be watched the whole time he's there. I get this funny feeling he'll be back soon, though...

Tuesday, April 1, 2008


Work Ramblings

You know how lately I've been ranting and raving at the MRSA epidemic, right? Well, the hospital administration, in all their wisdom, has decided to join the other hospitals around the country and do something about it. Now, every patient admitted to a floor has to be tested for MRSA infection. Sounds cool, right? Surely if we catch it right when they come in we can isolate them right away and they won't infect anyone else, right? Sure, it sounds that way if you don't know anything about MRSA (and I didn't either at first, don't feel bad). I have a few problems with it though:

Firstly, many people are infected with MRSA but cannot spread it to other people easily. Usually, the MRSA has "colonized" and isn't virulent. I would be willing to bet a large sum of money that myself and my coworkers would all test positive, yet are not able to transmit it to any of our patients. This is why healthcare workers aren't being screened. We'd all test positive, they'd have to forbid us from coming to work and they'd find themselves with a very small number of working employees.

Secondly, and I've said this in previous posts, superbug infections have no place on a postsurgical cardiac floor. Period. End of discussion. Yes, it's nice to imagine working in Fantasy Memorial Hospital where every doctor, nurse, housekeeper, maintenance worker, and visitor washes their hands between rooms, but it ain't happening. We have to start allowing for some human error here.

Thirdly, it completely trivializes something that is deadly serious. I can't name all the times I've heard in report, "Oh he's on isolation for MRSA, but it's just a positive screen for the colonized stuff in his nose". Now, I'll still wear gloves when entering the room, but I'll be willing to bet that there's a bunch that won't at that point. The habit of treating isolation precautions seriously is now broken. You get some dumbass aide that assumes the isolation cart now means "colonized MRSA", and won't glove up for a shingles or actual MRSA patient. Congratulations, you've now spread the disease.

Yes, MRSA is serious business. Yes, I agree with the fact that sometimes the infection is hospital acquired from the "error" of someone not washing their hands and the hospital and employees should be held accountable for that. But this seriously isn't the way to do it.

However, nobody listens to me (unfortunately) and I fear that this is the way of the future. Medicare has stuck its greedy little nose into the situation and is making its money talk. "Beginning October 2008, hospitals will receive lower Medicare reimbursement if their inpatients suffer from 'hospital-acquired conditions' which were not documented as 'present on admission'." (article HERE). Okay, fine, this is understandable. It's the "you break it, you buy it" principle. Only here it's "you infect it, you pay for it". Again, good and right and fair in Fantasy Memorial Hospital. In reality, it has a few problems.

Most of the postsurgical cases my floor gets are open heart surgeries (CABGs.) They're given strict instruction during their stay (as well as constant nagging) to NOT use their arms to lift anything heavier than a gallon of milk for six weeks after their discharge. This includes using their arms to move around or assist with sitting or standing. Obviously, we get some noncompliant patients. They go home, don't bathe, and use their arms for everything they did before the surgery. Well guess what. They come back with MRSA infections nine times out of ten. It's their on stupid fault and no one can say they weren't educated constantly while they were in the hospital. Well, now they get a free 3-4 week hospital stay!!! Woohoo! NOT. There goes my yearly bonus. And the next 50 years' bonuses too. But Medicare damn sure won't pay for it since they didn't have MRSA when they entered the hospital before their surgery.

Healthcare theory and policy today and in planning for the future relies way too much on the intelligence of people. Politicians, including Clinton and Obama, spout that the only way to reform healthcare is educate people! No way people will get Type 2 diabetes if they KNOW they can get it!!! Bull fucking shit. There's not a smoker alive that isn't educated about what smoking does to them. The fucking warning's on the fucking box. But they do anyway! People today (and yes, I do actually include my obese self) see no reason to make sacrifices for their health. Educate all you want, they will still eat that Twinkie and get diabetes, smoke that cigarette and get COPD, drink a bottle of vodka a day and go into liver failure, and sit on their ass all day and get heart disease. Education is NOT the cure-all these idiots are spouting it to be.

Just because the patient didn't do what they were taught doesn't mean it's the hospital's responsibility when they very thing we said would happen, happens. It's a good start, but people need to start taking responsibility. And I think and exit MRSA swab in addition to the entrance swab is a really good place to start.