Nurse Ratched’s Place

Title: Paul Younger’s military physical exam. Creator/Contributor: Daily News (Los Angeles, Calif. : firm), Publisher. Date: ca. 1950.

Say ahhh. This is a very tall patient or a very short doctor. I hope the doctor isn’t afraid of heights. I received this email from my mother today, and I about spit Pepsi all over my computer screen as I read through this list. I’m sure everything in this letter is true because no one can make all of this stuff up. Enjoy!

EMBARRASSING MEDICAL EXAMS

1. A man comes into the ER and yells, “My wife’s going to have her baby in the cab!” I grabbed my stuff, rushed out to the cab, Lifted the lady’s dress, and began to take off her under- wear. Suddenly I noticed that there were several cabs —and I was in the wrong one.
Submitted by Dr. Mark MacDonald, San Francisco

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient’s anterior chest wall. “Big
breaths,” I instructed. “Yes, they used to be,” replied the patient. Submitted by Dr. Richard Byrnes, Seattle, WA

3. One day I had to be the bearer of bad news when I told a Wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a “massive internal fart.”
Submitted by Dr. Susan Steinberg

4. During a patient’s two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. “Which one?” I asked. “The patch, the Nurse told me to put on a new one every six hours and now I’m running out of places to put it!” I had him quickly undress and discovered what I hoped I wouldn’t see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one.
Submitted by Dr. Rebecca St. Clair, Norfolk, VA

5. While acquainting myself with a new elderly patient, I asked, “How long have you been bedridden?” After a look of complete confusion she answered. “Why, not for about twenty years – when my husband was alive.”
Submitted by Dr. Steven Swanson-Corvallis, OR

6. I was performing rounds at the hospital one morning and while checking up on a woman I asked, “So how’s your breakfast this morning?” “It’s very good, except for the Kentucky Jelly. I can’t seem to get used to the taste” the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled “KY Jelly.”
Submitted by Dr. Leonard Kransdorf, Detroit, MI

7. A nurse was on duty in the Emergency Room when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing, entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, “Keep off the grass.” Once the surgery was completed, the surgeon wrote a short note on the patient’s dressing, which said, “Sorry, had to mow the lawn.”
Submitted by RN no name

AND…………….

8. As a new, young MD doing his residency in OB , I was quite embarrassed when performing female pelvic exams. To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, “I’m sorry. Was I tickling you?” She replied, “No doctor, but the song you were whistling was, “I wish I was an Oscar Meyer Wiener”.
Dr. wouldn’t submit his name

Now that you have had your chuckle for the day, head on over to Emergiblog for Change of Shift. Kim put together another great selection of posts to keep the good times rolling.

Can you guess who is standing on the right in this picture? This picture was taken back in 1976. Here’s a hint: He loves Macs, iPods, and iPhones, and he turned into one of the hottest looking guys on the planet.

Answer: The geek pictured above is Steven Jobs. If I had played my cards right back then, I could be married to a bizillionaire now, and I could have been the proud owner of an iPhone and every other cool computer gadget known to mankind. I was always attracted to the brainy type. It’s too bad that Steven and I never met. I bet he liked nursing students. Darn, another missed opportunity to live happily ever after with the geek of my dreams.

If you missed your opportunity to get a free iPhone like I did, then check out this chance to win a free iPhone from Nursing Voices. Nursing Jobs.org is working with Nursing Voices to give away two free iPhones to active and deserving forum participants. Here are the contest rules. Go check it out. I can’t play because I’m a forum moderator. Darn, another missed opportunity to get a free iPhone! Sometimes life just isn’t fair.

I’m still looking for the perfect job, and my friends are trying to help. One of my friends, who is an attorney, told me not to send my application to a particular Washington D.C. hospital. He said it would be a waste of time because I’m not their “type.”

The facility, nestled in an upscale area of Washington D.C., caters to the nation’s rich and powerful. It’s where the beautiful people go when they are having a rough time. The hospital is holding their nurses to new and unusual standards, and these standards were brought to my friend’s attention when a nurse from this hospital came to his office for help. She said that the medical director called her into a meeting and informed her, in front of witnesses, that she is too old and ugly to work at their hospital. He explained it’s about marketing, and that the hospital is updating its image. He said that only young, beautiful nurses would be allowed to work at the hospital. He also said that patients want beautiful nurses taking care of them, so she had to go. She was shown the door after thirty years of faithful service to the hospital. I’ve often thought that aging nurses would someday face age discrimination, but I never thought it would be brought up in such a blatant manner. Fortunately, this nurse has options because the medical director was stupid enough to make his insulting statements in front of a room full of witnesses.

Personally, I refuse to get a face-lift, a tummy tuck, and a boob job just so I can find or keep a job. I asked my friend why he told me about this hospital. Did he think that I was old and unattractive? He said he should have known not to discuss age and aesthetics with a woman of my “advanced years.” It’s a good thing that he is one of my best friends. I may be old and wrinkled, but I can still kick butt.

This Phoenix and I have something in common. We both have risen from the ashes and have been reborn, or in my case, I have come back to life after my bout with a brutal cold. It was really hard going into work this weekend. I couldn’t call in sick because I had a pulse, I was somewhat able to breath, and because I’ll loose my job if I miss too many weekend shifts. I’m only allowed to miss six shifts per year, including time off for vacations. The only time a nurse is allowed to call in sick at Hospital X is if they are dead, but only if their next of kin can bring a copy of their death certificate to the nursing office. The nurse I was working with was also sick, so the patients were hesitant to approach the nurses station. They didn’t want to get sick, too. One lady asked if she could make us some tea. Another patient brought my colleague a blanket to curl up in when she spiked a fever and started chilling behind the desk. One of the unit troublemakers didn’t make waves because he felt sorry for us. Finally, a patient stated the obvious when he said it’s a shame that the hospital doesn’t care about its nursing staff enough to let us stay home when we are sick. And people wonder why there is a nursing shortage.

I want to thank everyone for their get-well wishes and for their kind thoughts and comments.

I’m sick, I’m really sick. I’m nursing a fever for the third night in a row. Fevers make me crazy. I’m hearing two voices in my head; a histrionic voice and a rational voice. This is what the voices are saying:

Histrionic voice: This is it; I’m dying. I can’t breath, I’m coughing, and I can’t eat. I have a splitting headache and my body feels like it is on fire. Maybe I have pneumonia, or….maybe it is the bird flu. It’s the end of all mankind! Goodbye world, I’m going to those pearly gates in the sky.

Rational voice: You have a cold you big baby. Shut up and take two Tylenol and call me in the morning. Oh, wait; I’m me. Never mind.

I’m sick, and yet I’m blogging. What’s with that? I’m spending my night with my Mac and the Grim Reaper. Now where did I put that darn Tylenol?

Today’s word is “Delusion”

I’m often asked to explain the meaning of words used in psychiatric nursing, so today I’m talking about delusions. Here is the classic example of a delusion:

Britney Spears demonstrated delusional thinking when she danced in her underwear while performing at the MTV’s Video Music Awards. She either sees herself as svelte, or she thinks that belly fat and thunder thighs are cute. Either way, she continues to prove that she has lost touch with reality. I don’t mean to be cruel, but the whole spectacle was painful to watch. A psychiatrist once told me that a delusion is a defense mechanism that people create to protect themselves from reality, and that we must not challenge their delusion unless we can replace it with something else.

Britney, I’m speechless.

It’s unusual when psychiatric nurses are required to learn about new medical technology. We don’t use many medical gadgets because our focus is on our patients’ mental health. As a psychiatric nurse, my practice primarily involves the use of medications and talk therapy. That, however, wasn’t always the case in psychiatric medicine. For example, this patient is being treated with hydrotherapy, also known as a hepatic douche. No, I’m not kidding, look at the fine print at the bottom of the picture. I found this picture in a book that was written and published by Dr. John Harvey Kellogg of Battle Creek, Michigan. He was the medical director of the Battle Creek Sanitarium. He believed that good food, exercise, and a daily dousing of water—inside and out—could cure any illness known to mankind. Dr. Kellogg came up with all kinds of gizmos that look funny today, but they were considered on the cutting edge at the turn of the twentieth century.

I’ve noticed that different types of talk therapy fall in and out of favor over the years, and I’ve seen a lot of changes throughout my nursing career. My nursing instructors believed that Freud was God, and taught us about the power of psychoanalysis. I never bought into the theory, which got me into hot water when I was in class. My psychiatric nursing instructor got rather peeved every time I rolled my eyes and giggled during her lectures. I reminded her on more than one occasion that sometimes, a cigar is really just a cigar. By the way, Sigmund Freud wasn’t only the father of modern psychoanalytic, he was the father of pop psychology books. In Psychopathology of Everyday Life, published in 1951, Freud is the first to bring modern psychiatry to the masses. This book first introduced the American public to the concepts of the Freudian slip and repression. If you ever find this book in good condition at a thrift store or flea market, grab it. This book is a first edition and it’s worth a lot of money.

Welcome to the days of lava lamps, Jimi Hendrix, and tie-dye shirts. This book is about recycling your life style the psycho-energetics way. Doesn’t that sound far out? Recycle Your Lifestyle was written by Dr. Paul Mok and was published in 1972. Dr. Mok tells readers that if they are ready for an “exciting lift off,” he will provide the answers to help them find nirvana. He tells readers how to recharge their psychic energy systems and resist and control negative energy forces while “getting it together.” I saw some doctors use this type of approach with their patients during the early days of my nursing career, but I doubt that today’s HMOs would think that this type of therapy is groovy.

And speaking of HMOs, check this out, and no, I’m not making this up. Brief therapy is now becoming very popular because HMOs refuse to pay for long-term treatment. During brief therapy, the therapist asks the patient what’s the problem, and then tells the patient if it works, do more of it, and if it doesn’t work, do something else. That’s it; they slap a Band-Aid on psychological issues and call it a day. Sad, isn’t it? I wonder what they are going to come up with next? Maybe we will go back to using hydrotherapy.

My mom sent this to me the other day. I thought it was cute. Enjoy!

A husband and wife came for counseling after 15 years of marriage. When asked what the problem was, the wife went into a passionate, painful tirade listing every problem they had ever had in the 15 years they had been married. She went on and on and on: neglect, lack of intimacy, emptiness, loneliness, feeling unloved and un-loveable, an entire laundry list of un-met needs she had endured over the course of their marriage. Finally, after allowing this to go on for a sufficient length of time, the therapist got up, walked around the desk and, after asking the wife to stand, embraced and kissed her passionately. The woman shut up and quietly sat down as though in a daze. The therapist turned to the husband and said, “This is what your wife needs at least three times a week. Can you do this?”

The husband thought for a moment and replied, “Well, I can drop her off here on Mondays and Wednesdays, but on Fridays, I fish.”

Look at this cutie. I bet she was saying, “When I grow up, I’m going to be a nurse.” Do you remember saying that when you were a youngster? Thank goodness for student nurses. Drop by How I spent My Nursing Education for this week’s edition of Change of Shift. Thank goodness we have so many wonderful young people entering the profession. Come check it out.

Student nurses ROCK!

Here is an old picture of Nurse Bookworm. She was alone in the library while all of her classmates were out having fun. My nursing instructors always gave us a pop quiz on our first day back to school after a holiday break. I don’t think they wanted us to enjoy our time off, and I bet Nurse Bookworm earned an A+ on all of her quizzes. In the time honored tradition of pop quizzes, please try to answer these intriguing questions that I found in the 1928 edition of State Board Questions and Answers for Nurses. Don’t worry if you don’t pass the test. I know that you were out having fun during the Labor Day weekend.

Question #1: What are the symptoms and treatment of acute arsenical poisoning?

Answer: “The symptoms of acute arsenical poisoning are tightness in the throat and great pain in the stomach region. Diarrhea occurs culminating in rice-water stools. There is prostration, retching and vomiting, and often, complete suppression of urine. Violent headache and pain in the muscles followed by collapse and coma occur in fatal cases. Death may ensure in twenty-four hours or may be delayed some days. The treatment is to evacuate the stomach immediately, either by administering mustard water, or apomorphine gr. 1/10 by hypodermic, or by the stomach tube. The hydrated oxide of iron and magnesia is the chemical antidote and should be given in gobletful doses. Keep the patient quiet, and , if the diarrhea has not commenced, give half a pint of very strong coffee by rectum.”

Question #2: What are the symptoms of zinc poisoning and what are the antidotes?

Answer: “Zinc salts, the sulphate and chloride, act as irritant poisons, causing nausea, vomiting, epigastric pain and diarrhea, ending in shock and collapse. The urine is scanty, containing albumin and casts—sometimes blood, and suppression may occur. The antidotes are carbonate or bicarbonate of soda, a tablespoonful to a quart of water, and milk.”

Question #3: Name five emetics and five alteratives.

Answer: “Mustard, sodium chloride, apomorphine, ipecac, and sulphate of copper are emetics. Potassium iodide, mercury protoiodide, colchicum seed, sarsaparilla, and arsenous acid are alteratives.”

Here’s my favorite question:

Question #4: Give technical names for brandy, whisky, cod liver oil, salt, and calomel.

Answer:

The technical name for brandy is spiritus vini gallici.
The technical name for whisky is spiritus frumenti.
The technical name for cod liver oil is oleum morrhuae
The technical name for salt is sodii chloridi
The technical name for calomel is hydrargyri chloridum mite.

So, how did you do?