Nurse Ratched’s Place

It looks like Nurse Adams misplaced her unit keys again. Psychiatric nurses flip out when they can’t find their keys. It’s not a good thing. A patient could find them and escape off of the unit. Then come the incident reports. Do I need to say more?

I learned my first lesson about unit keys when I cared for an old retired army nurse. She was a patient at a VA hospital. My patient had worked as a psychiatric nurse in a military hospital during World War II, and I was there when she was admitted onto our unit. I don’t remember her diagnosis, but I think that she may have had Alzheimer’s disease. Her first day on the unit didn’t go so well. She looked panicked, and she kept patting her pockets. She scurried around the unit and fought back tears as she tugged at the unit doors. She said that she was making sure that they were locked. I was a novice psychiatric nurse back then, and I didn’t know what was going. A veteran psychiatric nurses clued me in. My patient thought that she was working on the unit and she couldn’t find her keys.

The next day one of our orderlies brought in a key ring filled with old keys. He walked up to the patient and asked, her, “Are you looking for your keys?” She grabbed them and held them near her heart. She was at peace.

Note to self: Sometimes it’s the simple things that patients need most.

I want this book. It’s been on my wish list for a long time, but I can never find a copy when I go shopping. I found this picture over at Tiny Pineapple. The website’s proprietor has the best nurse book collection that I’ve ever seen. Seriously, I’m totally jealous.

Meet Vicky Blair, R.N. She’s the nurse testifying in court. She’s drop dead gorgeous, she has many handsome suitors, and she works at a glamorous, upscale hospital. Some girls have all the luck, however Vicky and I do have a couple of things in common. We both hate testifying in court, but we do it because it’s the right thing to do.

This drama started a few months ago when a patient, Mr. Jailbird, attacked four nurses at the Greatest Hospital in the World. He tried stabbing my coworkers and me, and I testified against him in court. Yesterday, I returned to court to give my victim impact statement and to be present during the sentencing phase of the trial. Mr. Jailbird arrived at court wearing a nice new suit, and he was accompanied by his public defender and by an entourage of caseworkers. His attorney told the judge that Mr. Jailbird is now a law abiding citizen that doesn’t belong in jail. She reported that he has been able to control his behavior since his last day in court. A caseworker also made glowing comments about Mr. Jailbird’s “fabulous progress,” and then it was my turn to speak.

As you can well imagine, I had a different point of view. I told the judge that I was so happy to hear about Mr. Jailbird’s good behavior. I said that it just proves that he can stay out of trouble when it serves his own purpose. I also offered the judge some additional information about the patient’s background that was pertinent to the case. Mr. Jailbird’s attorney stood up and started screaming something about HIPAA. The judge told her to sit down and to be quiet. He said that as the victim of a crime, I had the right to speak my mind in court. As a side note, HIPAA goes out the window when you are testifying in criminal court.

So the judge and I continued to have our little chat over the bench while Mr. Jailbird’s attorney continued to have a stroke. I asked the judge not to send Mr. Jailbird to a state psychiatric hospital. I said that Mr. Jailbird knows how to manipulate the system, and that he could be discharged within 30 days of admission if he told his doctor that he wasn’t a risk to himself or others. I concluded my statement by saying that Mr. Jailbird needed to go to jail because he needed to suffer the consequences of his actions. A lot of people have “issues”, but they don’t try killing three old nurses, a pregnant nurse and her unborn child.

The judge looked grim. The information in my victim impact statement really upset him. The judge said that Mr. Jailbird was manipulating the system. I thought Mr. Jailbird’s attorney was going to pass out. The judge deferred sentencing once again, and our next court date is February 26th, 2009. He said that he would sentence Mr. Jailbird after he had a chance to review ALL of the facts. As I was leaving the courthouse, I was accosted by one of Mr. Jailbird’s caseworkers. She started screaming at me in the courthouse lobby in front of courthouse security staff. She told me that, as a mental health professional, I had no right to be “mean” to Mr. Jailbird. She’s not too bright is she? Stupid people. I’m looking forward to my next day in court.

The handsome lady in the picture is my Great Grandmother Lottie Lind. By all accounts she was a petite little thing with a wicked sense of humor. She had to have a sense of humor to put up with my father as a little boy, but that’s another story. Lottie was from Sweden and I found a letter that once belonged to her when I was going through some family heirlooms. I have no idea what this letter says. I’m assuming that it is written in Swedish.

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Please contact me know if you can read the contents of this letter. Hopefully the letter describes the location of a hidden family treasure, which will allow me to retire from nursing. I think I’ll pack a bag and start looking at cruises, you know, just in case.

A middle-aged woman seemed sheepish as she visited her gynecologist. “Come now,” coaxed the doctor, you’ve been seeing me for years. There’s nothing you can’t tell me.”

“This one’s kind of strange,” said the woman.

“Let me be the judge of that,” the doctor replied.

“Well,” she said, “Yesterday I went to the bathroom in the morning and heard a plink-plink-plink in the toilet and when I looked down, the water was full of pennies.”

“I see.”

“That afternoon I went to the bathroom again and, plink-plink-plink, there were nickels in the bowl.” That night,” she went on, “I went again, plink-plink-plink, and there were dimes and this morning there were quarters! You’ve got to tell me what’s wrong with me!” she implored. “I’m scared out of my wits!”

The gynecologist put a comforting hand on her shoulder. “There, there, it’s nothing to be scared about.”

(Ready for this?)
(I’m warning you…..)

“You’re simply going through the change!”

I warned you. Have a nice weekend.

She is disciplined and dainty,
She’s dependable and neat,
Careful, capable and canny,
Cool, courageous, smart and sweet;

She is soft as silk or satin,
She’s as hard as any nail,
Has woman’s intuition
With the logic of the male.

She contends with circumstances
That would shatter nerves of steel,
Yet she’s jestful, faithful, zestful,
Though she shakes from head to heel;

She’s a messenger of mercy
From the Prince of Peace and Love,
She’s sagacious as a serpent,
She’s as harmless as a dove.

She’s the servitor of Science,
She has wisdom deep and wide,
She is forceful, fast, resourceful,
Calm, unhurried, dignified;

She’s the daughter deft of Duty,
Sent to seek and serve and save,
And she’s on the job forever,
From the cradle to the grave.

(Published in “The Gusher” Vol. 4 by the Senior Class of Bradford Hospital Training School in 1929.)

Meet LeRoy. He was a pharmacist back in the early 1930s. LeRoy is teaching Dr. Baggy Pants about a new fangled medication that just hit the market. I bet it was something really cutting edge like penicillin. Pharmacists know everything that there is to know about medications. It’s what they do. They are professionals.

Some pharmacists, like LeRoy, live for pharmacology. Then there are some other pharmacists who just live to do drugs. I guess it’s true what they say about some people becoming pharmacists just so they can get their hands into the pharmaceutical cookie jar. One such pharmacist is Mr. Pill Head. His world came crashing down around his ears last week when he had a run in with the law. The rumor mill at the Greatest Hospital in the World was churning, so I checked out the public record to find out what was going on. My jaw dropped. According to police reports, Mr. Pill Head had allegedly crashed into five cars while he was under the influence of controlled substances, left the scene of an accident, and had been selling drugs out of the back of his car. I’m sure that he wasn’t speeding down the road in an attempt to escape from police. He was just trying to get into work on time so wouldn’t miss JCAHO. Too bad he didn’t make it into work. I would have paid anything to watch JCAHO inspectors insist that Mr. Pill Head pee into a cup. I’m sure that our hospital administrator would have just passed out.

I can only imagine what LeRoy would have thought about Mr. Pill Head’s drug habit. I’m sure that pharmacists sampling their own wares isn’t anything new. I’m also sure that Mr. Pill Head can kiss his professional license goodbye.

One of my coworkers said that it was like a scene out of the Wizard of Oz. The twister was coming and everyone was running for their lives. I’m really sorry that I missed JCAHO’s grand entrance into the Greatest Hospital in the World. Our unit was chaotic. It was filled with wild patients, and as always, we were understaffed. I heard that my boss called my other coworkers, begging them to come into work. They all declined her invitation. I guess my boss misplaced my home phone number. I never got a call. Maybe she was afraid that I might tell one of the inspectors about the JCAHO Readiness Swat Team, and what really happens on the unit.

Sometimes it pays to be a smarty-pants.

Welcome to Election Day at Grand Rounds. I want to thank Colin and Dr. Val for allowing me to serve as host. I needed the diversion. I don’t know about you, but I’m glad that this election season is coming to an end. Hopefully we will know who our next president is by the end of the night. Pray that no one finds any hanging chads!

The President of the United States has a few things in common with people like Joe the Plumber. From time to time, everyone gets sick and needs to see a doctor. I remember when George H.W. Bush vomited all over a Japanese Prime Minister during a state dinner. And we all remember the attempt on Ronald Regan’s life. Whatever happens, the president’s physician stands ready to care for their famous patient and members of the First Family. Today we are going to review the health history of former presidents at Grand Rounds.

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Editor’s Choice For Historical President of the United States: Franklin Roosevelt was the 32nd President of the United States. FDR served four terms in office and was a central historic figure during the days of the Great Depression and World War II. I think he would know what our next president is going to be up against when he takes the oath of office.

At the age of 39, Roosevelt had a severe attack of poliomyelitis in 1921, resulting in total paralysis of both legs to the hips. Roosevelt refused to accept that he was permanently paralyzed. As a result of his illness, he established the Roosevelt Warm Springs Institute for Rehabilitation, and helped to found the National Foundation for Infantile Paralysis (now known as the March of Dimes). His leadership in this organization is one reason he is commemorated on the dime.

Roosevelt, a chain-smoker, had chronic high blood pressure, emphysema, atherosclerosis, angina pectoris and end-stage heart disease. Dr. Emanuel Libman, then an assistant pathologist at Mount Sinai Hospital in New York City, predicted that Roosevelt would die of a cerebral hemorrhage within the first 6 months of his last term in office. President Roosevelt died on April 12th, 1945 of a massive cerebral hemorrhage.

The Editor’s Choices: Doc Gurley sent in this post that talks about the five things to do for your health this November. The top thing on her to do list is to VOTE! Please follow the doctor’s orders and go out today and vote for the candidate of your choice.

There has been a lot of speculation over the years that FDR had a malignant melanoma excised while in the White House. Between 1920 and 1932 FDR developed an enlarging pigmented lesion above his left eye. This lesion vanished between 1940 and 1944, leaving a scar and a sparse lateral eyebrow. During lectures in 1963 and 1965, Dr. George Pack stated that his friend, Dr. Frank Lahey of Boston, had seen FDR in consultation in 1944 and had informed the president that he had a metastatic tumor, and advised him not to run for a fourth term. Dr. Val Jones from Getting Better with Dr. Val just interviewed a world renowned expert on Lupus, and she thinks that he had some interesting things to say about promising new research in the field. How close are we to finding a cure for cancer? Read Dr. Val’s post and find out.

Kim from Emergiblog wants to help a veteran who is dying from cancer. Please read her touching post about how members of our blogging community are helping this gallant fighter. Way to go Grunt Doc!

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John F. Kennedy became the thirty-fifth president of the United States after a scandal-ridden race for the White House. A lot of dead people in Chicago voted for Kennedy. He was also the first Irish-Catholic President of the United States. I know that it sounds kind of strange now, but back then it was a big deal. People were afraid that Kennedy would take his orders from the Pope. Kennedy wasn’t thinking about the Pope. He had a lot of health issues on his mind. In 1937 Kennedy started taking steroids to treat colitis. This caused many long-term side effects that haunted him for the rest of his life. Kennedy suffered from Addison disease as well as chronic back pain possibly related to weakened bones caused by steroid use. Laika from Laika’s MedLibLog sent in a post that discusses the importance of early intervention in Addisonian crises.

David Harlow from HealthBlawg sent in a post about a local Catholic health care system getting big bucks from a large national Catholic system. David thinks that it all sounds a bit scandalous, just like Kennedy’s race for the White House.

According to a couple of sources, Kennedy received last rites three times during his lifetime: Once on the ocean liner Queen Mary in September 1947 after being diagnosed with Addison disease, in 1954 when he fell into coma after he had surgery for a urinary tract infection, and when he was shot on November 22, 1963. There is a legend that Kennedy’s heart was resuscitated shortly after he arrived at the Parkland Hospital ER in Dallas. In any event, there are more questions than answers related to Kennedy’s assassination. Dr. Jolie Bookspan from Healthline sent in a post about forensic identifiers. Identifiers answer questions. Don’t read this post while you are eating. It might ruin your appetite.

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William Henry Harrison was the 9th President of the United States. Harrison
almost became a physician. As a young man he enrolled for the two 16-week courses at the University of Pennsylvania that would have led to an M.D. degree, however he didn’t finish the course. Maybe he needed more help getting through medical school. Adam Rosh from Detroit Receiving, The Place For EM, sent in this post about Tracings, written by Dr. William Berk. Tracings is a learning module involving actual cases of patients and their ECGs that present to the Emergency Department. Topics are derived from the EM Model for Resident Education. This sounds like a great learning tool for medical students.

Dr. Chris wrote two great posts at AppleQuack. One post teaches medical students how not to look stupid and the other one teaches them how to study a medical condition. This information is meant to help medical students become doctors that are able to treat all types of illness. Too bad that President Harrison didn’t have a doctor who could treat pneumonia appropriately. Harrison gave a two-hour inaugural speech on a cold, wet day in March of 1841. He developed right lower lobe pneumonia and “congestion of the liver.” His doctors applied suction cups to his chest to draw the evil out of his body. When that didn’t work they gave him ipecac to induce vomiting. They also gave him calomel and castor oil to purge his bowels. As a last resort , they tried opium and brandy, Virginia snakeweed, a Seneca Indian remedy. Nothing worked. Harrison was the first president to die in office. He died one month to the day after his inauguration.

I guess back then it did not matter what kind of government healthcare plan you had. Without good care, you were dead. Adina Cappell from Heal Spiel sent in a post about the time the McCain and Obama campaigns held a debate at her med school. She reviews how each candidate would fix our ailing health care system.

DrRich from The Covert Rationing Blog believes that everyone has the right to health care, and it doesn’t have anything to do with the BOSS rule. You’ve got to read this post.

Sam Solomon from Canadian Medicine wrote a post about the Cabinet shakeup that’s going on in Canada. Read about Canada’s new health minister.

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Warren Harding was the 29th President of the United States. President Harding was a big fan of homeopathic medicine. Both of Harding’s parents were homeopathic practitioners, and Harding chose a homeopathic physician to be his personal physician while serving in the White House. President Harding was also a big fan of Dr. J.P. Kellogg and the famous sanitarium in Battle Creek, Michigan. It’s been reported that Harding paid five visits to the sanitarium between 1889 and 1901 to recover from fatigue, overstrain, and nervous illnesses. Harding also suffered from heart disease, hypertension, and diabetes. Too bad that Harding didn’t have access to support groups that could have given him emotional support as well as additional information about his medical conditions. Amy Tenderich from Diabetes Mine sent in this guest post written by Alexis Pollack. Alexis writes about a woman with Type 1 diabetes is “working on the inside” at a major pharmaceutical company. I really encourage you to visit Amy’s website. It’s a great resource for anyone who is living with or caring for someone with diabetes.

Here’s another great website for anyone interested in diabetes. The power of the diabetes community shows itself again! Kerri Sparling, type 1 diabetic and author of Six Until Me, writes about an episode of Hannah Montana that misrepresented type 1 diabetes, calling for action in the diabetes community to make a difference. The episode, scheduled to air on November 2nd, was PULLED by Disney representatives after an outpouring of emails from the diabetes community.

Patients living with chronic pain need a lot of support, too. The National Institutes of Health has put together a podcast about vulvadynia, a painful pelvic disorder in women. Check it out at How to Cope with Pain.

Patients and health care professionals are finding more ways to use the Internet to communicate with each other about health care issues. Dr. Ves Dimvo from Clinical Cases and Images sent in this post that tells how Dr. Theresa Chan is using Twitter to communicate with her health care colleagues. And speaking of the good doctor, Dr. Theresa Chan from Rural Doctoring sent in this post that explains her point of view about health care reform.

Dr. Walter Jessen from Highlight Health 2.0 writes that people are using the Internet more than ever to search for health or medical information online. Read his post about a health 2.0 service that combines a vertical health search engine with a patient-to-patient social network.

David Williams, the author of the Health Business Blog, sent in a post containing a transcript of his recent podcast interview with Telerays CEO, Dr. Daniel Roubein. The Telerays platform is designed to help connect health care professions.

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William Taft was the 27th President of the United States. He was also the heaviest U.S. president on record. Taft struggled all his adult life with a weight problem. He got stuck in the White House bathtub and had to have an oversized version brought in for his use. Taft was 5 feet 11.5 tall and weighed 335-340 pounds near the end of his presidency. Fortunately, he was able to drop a lot of weight after leaving office in 1913. I wonder if he was a stress eater. Taft suffered from hypertension and sleep apnea in addition to lumbago, gout, motion sickness, TMJ, and constipation. Jeffrey Leow from Monash Medical Student submitted a post about a patient who had a couple of things in common with President Taft. Read his post about a patient who lost a lot of weight after having a high gastric reduction and then developed obstructed defecation.

The good people from ACP Internist sent these posts my way. Did you know that a recent BMJ report just came out? It said that adults who eat rapidly or until they’re full are more likely to be overweight. I guess Taft wasn’t only a stress eater, he was a fast eater, too. Check out both posts for information about a variety of subjects.

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James Monroe was the 5th President of the United States. Monroe suffered from many aliments including problems related to a war injury. In 1776 Monroe took a bullet in the left side of his chest during the Battle of Trenton. The bullet grazed the left side of Monroe’s chest, then hit his shoulder and injured the axillary artery. A doctor saved Monroe’s life by sticking his finger into the wound to stop the bleeding. Surgeons were unable to remove the bullet and he carried it in his shoulder for the rest of his life. Monroe also suffered from reoccurring bouts of malaria. He contracted malaria while visiting a swampy area of the Mississippi River in 1785. Monroe had a noteworthy seizure in August 1825 that was possibly caused by cerebral malaria. The seizure was so severe that it almost killed him. Monkeygirl from Musings of a Highly Trained Monkey took care of a woman who was having fake seizures. The only noteworthy thing about the event was the woman’s sock. You’ve got to read this post.

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Theodore Roosevelt was the 26th President of the United States. Known to the public as Teddy, Roosevelt was a hunter, explorer, solider, historian, author, and naturalist. He was the Rough Rider who walked softly and carried a big stick. Roosevelt believed in euthanasia, and he was the first president to call for universal health care and national health insurance.

Teddy was the model of masculinity. He was big and strong, but he had health issues just like everyone else. Roosevelt had very poor eyesight and got knocked out a few times while playing polo. He snored, was obese, and was blind in one eye. Roosevelt ran for President in 1912 as a third party candidate. During his campaign, John Schrank, a psychotic New York saloonkeeper, shot Roosevelt at close range during a campaign stop in Milwaukee. The bullet passed though a fifty-page speech and a steel spectacle case in Roosevelt’s breast pocket before it lodged into the right side of his chest. Roosevelt received treatment and was released 8 days later from Mercy Hospital, located in Chicago. Roosevelt also suffered from malaria in his later years.

Despite his physical limitations, Roosevelt will always be remembered as a great adventurer. Dr. Paul Auerbach from Healthline also loves a good adventure. He swims with great white sharks. You read that right. Now read his post.

Wozzer from The Beauty of Motion also loves going on big adventures. He sent in a post about his trip to Italy, and describes his experiences and emotions as an Orthopedic Surgeon.

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Thomas Jefferson was the third President of the United States, and as we all know, he was the principal author of the Declaration of Independence. Despite the health issues that plagued him throughout his life, Jefferson was also a horticulturist, statesman, architect, archaeologist, paleontologist, author, inventor, and founder of the University of Virginia. Historians also remember Jefferson as the most influential Founding Father for his promotion of the ideals of republicanism in the United States.

From age 19, Jefferson started experiencing raging headaches that would leave him incapacitated for six weeks at a time. These headaches would come every 7-8 years and seemed to correlate around deeply emotional events in his life. John Bumgarner, the author of The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician’s Point of View concluded that these were a form of cluster headaches, but also believes there was a tension component, as horseback riding offered relief. Jefferson suffered from an episode of disabling “‘rheumatism,” periodic bouts of depression, and chronic back pain related to a back injury he suffered while working on his Monticello estate. 3+speckled from Rheumination: Rheumatology, Medicine, Science sent in a post about the Placebo Treatment of Fibromyalgia. I wonder if rheumatism is related to fibromyalgia. I hope doctors back then didn’t treat it with sugar pills. (Short editorial) I think that giving placebos to patients is just wrong.

Jefferson could have used the advice of Dean Moyer from the Back Pain Blog. Dean offers an explanation as to why even physically fit people develop lower back problems in, Back Pain is Not About Strength. He proposes that one reason athletes and otherwise healthy men and women develop back pain is that they often overlook important key elements of fitness; not the least of which are exercises specifically designed to lubricate your joints.

Jefferson required glasses from “middle age” on in order to read. Dr. Nancy Brown from Teen Health 411 sent in a post about sore eyes during homework. Just because you’re not middle age, doesn’t mean that you may not need glasses.

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Thank you for stopping by for Election Day at Grand Rounds. I would be remiss if I didn’t tell you where I found most of my presidential health information. To learn more fascinating information about our former presidents, please go and visit Dr. Zebra . He said that the Zebra is fake but that the doctor is real. Tell him Mother Jones, RN sent you. Next week’s host of Grand Rounds is Dr. Rob from Musings of a Distractible Mind. Send submissions to dr.rob.questions(at)gmail(dot)com.

Another reason why I’m glad that this campaign season is almost over.

Dr. Dedwin and Nurse Necro want to remind you that it’s time for Change of Shift. This week’s host is Amanda at Crazy Miracle Called Life. They want you to go check it out NOW. You better do it. If you don’t, Dr. Dedwin is going to send his friend Chucky over to your house. And while we’re on the subject of blog carnivals, don’t forget to send in your post for the next Grand Rounds. Send your submissions to motherjonesrn AT yahoo DOT com. Deadline for submissions is November 2nd.

Happy Halloween!