G's-Spot

Holy Crap! Ricin Found in Vegas Hotel--While We're Here

Okay, I thought the Hep C report was scary but early tonight there was something much worse.  Just down the road from here, near the Palms and Rio, they found a substance in an Extended Stay hotel room that the first tests are confirming as Ricin (poison!) in powder form. 

Remember the Ricin that was used as an aerosol spray in the Tokyo subway?  Yeah, well some of that in powder form was found here, blocks off the main strip.

On the 11pm news they showed the area blocked off and the teams of local cops, HAZMAT, and they also said the National Guard had come in to join the investigation too.

This is scarier than when we were in Vegas the week post-Christmas after 9/11 and there were rumors that terrorists would try to take out a hotel here by hijacking a jet.  Gene and I were staying in a suite on the next to top floor of the Mirage which is basically north (if I've got my directions right) of the airport.  Anyway, normally the air traffic wouldn't fly over the Mirage but on the morning of New Year's Eve when we were getting up to head home at noon, I woke up to the sound of a jet coming right at the hotel. I'm not kidding when I say waking up to that sound was one of the scariest moments of my life before I realized that 1) it was going OVER the hotel and 2) they'd diverted the air traffic due to high winds which does happen occasionally but because I woke up from a sound sleep it took me a minute to get that squared away in my head.

Gene slept through it.  I couldn't wait to get out of town that day.

The Definition of Fear: Hep C from the local Endoscopy Clinic here in Vegas

I'm sure you all heard about it on the national news today. We woke up to the local news breaking the story of a local Endoscopy clinic passing along Hep C for sure to 6 people. The local health dept tracked three acute cases of Hep C back to the same day in that same clinic and then really investigated. So far they've found three other cases from that clinic and they sent out 40,000 letters to people recommending they get tested for Hep C, A, and E (E?) and HIV.

They've only linked Hep C so far, but still.  I'd be pissed off and freaked out if one of those letters came to me, especially with the circumstances.  They found that anesthesia needles were being reused and/or med vials being reused, contaminating blood back and forth between who knows how many patients and for how long.  They're going back all the way to patients who received services in 2004 and forward because they can connect one of the Hepatitis cases to 2005.

You know, I'm not much into conspiracy theories but if they found three acute hep cases from the same day, three more from different times, and they're looking at 40,000 people over 3 years....that doesn't sound like one isolated employee who's being sloppy. To me, that sounds like a very negligent policy of cutting cost and corners on meds. 

Can you imagine getting one of those letters?

Oh, and the clinic's not paying for the testing, the individuals are responsible for obtaining and paying for their own testing from their primary care physicians.  Maybe it's a small price to pay for peace of mind, but again, if that news came to me, I'd be hot about it.  How about you?

Endoscopy Clinic News Story

Vegas Report 1: Soprano's, Sharks, and Sushi

The full report is on the food blog--click here:  Vegas Report 1.

Just a few more words about BODIES,The Exhibition. 

It was so incredible! Even if I wasn't in medical now I would have found it fascinating but after working for a little while now I think I appreciated it so much more than I would have before and I feel like I gained some work knowledge too. It was fun to go over those muscles again and see all those parts, for real, again now that I'm out of school.  The exhibit includes every organ dissected from every angle, showing the structure, the internal structures, the arteries and veins, ligaments, etc.  It's so detailed it's just incredible. Okay, how many times can I type "incredible" before I lose my license to type, but really.  I was so impressed and glad we went.  I stayed the longest in the heart and lungs room.  They showed so many lungs from all views: healthy, cancerous, emphysematous (sp?), stripped down to the bronchial tree, (beautiful! like the crystaline entity from Star Trek, The Next Generation) the veins and arteries, the alveoli so tiny,  fragile-looking, and multitudinous, etc. 

The technology behind the exhibit is that they used real bodies (and even fetuses) that were dissected to where they needed to be for the display, then submerged in acetone to remove all the H2O, then submerged in a silicone bath and vacuum sealed.  That makes the acetone turn to gas and leave the body with the polymer staying as complete preservation. It's freaky beautiful.

Seriously, I highly recommend this exhibit as educational, inspiring, and body art in the flesh for real.

I'm on va-CA-tion!

Yay!  Nice to get out of town for a while...and guess what I've done so far? Absolutely nothing. It's veen fantastic! No to-do list, no head full of shoulds...ahhh...so basically I've slept. We got in last night at midnight to the Luxor (East tower). The room is nice. Gene splurged on a suite package and I do love the decor.  It's a nice comfortable mix of Egypian, art deco (duh), and contemporary. 

I haven't left the room yet. 

I know. Seems sad but I'm having a great time.  Gene went to bed about 1am. I couldn't go to sleep until abot 7am, just stayed up watching CNN and watching the lights out the window. We face the airport which might not sound cool but Vegas has so much air traffic that it was lovely to turn the lights off in the living room and just watch the jet lights coming in over the mountains and landing.

Slept until 5pm today! It was GREAT. Anywone with insomnia knows what I'm talking about. Gene said he knocked around the room, took a shower, made some phone calls, and I never stirred so he figured I needed the sleep more than I needed to be bothered to get up so he left before noon to go get the rental car and played some poker. He finally woke me up so I'd sleep some tonight.

I feel great!

Off to get some dinner and play for a while...

But before I do...does anyone else hate to fly? I didn't realize until this trip just how much I hate to fly. I don't normall have claustrophobia but I realized I really wanted off the tin can this time.  I don't know why either.

One funky thing--the night before we left I had a recurring nightmare all night long that someone on our flight arrested and I was doing CPR on the plane. Gene laughed in my face and I laughed at the silliness too but then this morning the story of the lady who died on that flight from Haiti to JFK is all over the news.

Cue the Twilight Zone music.

Okay, off to play...

Nursing vs. Respiratory

I had an interesting and somewhat disturbing conversation with a nurse the other night. She happens to be a nurse on the pulmonary floor who was complaining about another RT who graduated after I did.  The example she gave, if completely true, did show the RT making a mistake BUT after I conceded that yes, of course, we're not supposed to diagnose, I also said "You know, we have licenses also and I cannot give a treatment in good conscience just because the nurse calls for one."  Well, as you can imagine that didn't go over well.

Most of the nurses, because of our very innovative protocols, are very happy to turn patients over to our steering when it comes down to respiratory issues. This nurse, as much as I like her personally, is very "my power". Granted she is the nurse and she is responsible for overall care but we're "a team" as I said several times, not just "ancillary" as she said several times.  I don't like to fight with people but on the other hand, I won't be dissed either. 

We did have a discussion that, thankfully, didn't become heated but we came to no agreement. She kept saying that respiratory is "just ancillatory" and I kept saying that we also have a license to protect and uphold and that we have to judge respiratory situations according to our training, that we don't just follow nursing orders.  Her response was "Fine. I'll get a doctor's order. I know how to make them give me what I want." I responded, "That's fine but I can call a doctor just like you can and have many times. I will not give a treatment to someone I know it will be uneffective on and I have many times called a doctor on fluid issues when it was appropriate."  She didn't like it much but I think we do have an understanding, especially when I explained that on the pulmonary floor, I personally trust them (RN's) but on other floors I get called for really ridiculous stuff like fevers and cardiac wheezes. 

Once I explained that, I think she understood a little bit more that we, as respiratory aren't just being cocky or power hungry, we're trying to ALSO act in the pateint's best interest.

Or maybe she didn't get it. I don't really care. What it comes down to is that I try to act int he patient's best interests and I'm happy that we have the protocols we do that allow me to pull ABG's before calling a doc and run my own vents, etc.  I love the nurses I work with on nights and I trust most of them implicitly but as I said, I also have a license to protect and specific knowledge about the lungs that could/should/ and will be of benefit to the patient. I'm not just a gopher, whether the nurse admits that or not.

Sunrise

Sunrise is my favorite part of leaving work. It literally lifts my spirits to see a beautiful sunrise on my way home.  It was another fulfilling night. Lots of running around but I still left thinking "That was a good night's work."

And I drove my two miles home looking at this:

By the way, the highlight of the night was that we got a CPAP order on a guy whose name just happened to be the same as a fictional movie character that you would all know. Now, our guy was in his 80's so he was obviously named first and I wish like hell I could tell you the name but that would be a HIPAA violation but it was GREAT! When the req first came across the printer I said "Is this a practical joke?"  I went upstairs and found the guy and said "Uhhh...about your name..."  He said, grinning, "I know. I get that all the time. Same name and I didn't get a damn dime from the movie!"  He was grinning so he really wasn't mad but it was way funny. Great guy with a wonderful wife. I was happy to go back in that room, delighted to help him with his home CPAP, wanted to go back just to hang out because they were so nice. You know what I mean? Some patients you'd just love to hang out in their room while others you can't get out fast enough. That guy was a keeper but I liked him so much OF COURSE I wanted him to get well quickly and leave so he could get on with his life. Such a nice man with a great sense of humor.

Back in the Saddle...so to speak...

Okay, work last night was back to being the place I love to be. For one, I had no nastygrams.  I was able to laugh with one of my favorite RT's who'd followed me after that bad day and she said I had one goofy thing but she just cracked up, couldn't remember what it was, fixed it, and went on.  So even though I was totally depressed the other day, she is the perfect example of why I love my job.  That's the way it should  be. Not that we shouldn't be counseled on our mistakes or held responsible but as she said, it was just a goofy end of the night mistake. She knew I knew what to do, it was just one of those things so she fixed it for me. And then gave me shit. Now THAT'S what I expect and love!

It was a full moon kind of night last night. Every ward had one patient they wanted to throw out the window.  It was just insane.  We had fakers and freaks and freebies looking to cash in on the hospital Hilton, if you know what I mean, and in between all of those we practiced some medicine.

On my favorite side of the night, I confided in a couple of my favorite nurses on the pulmonary floor some of the insane A&T requests we get on the non-pulmonary floors and all night long all the nurses on that ward gave me non-stop hell, calling me with ridiculous requests and giggling in the background. It made my night! I just loved it!  At the end, I came downstairs and we all laughed until we started waking up patients and then we had to cool it.

Then to top it off, Peggy and a bunch of us were sitting in the dept when the phone rang and she answered it "Respiratory. This is Glenna."  OH MY GAWD, we were doubled over in laugher. Thankfully it was a nothing call. I was sitting there banging my head on the desk, saying  "I'm not doing it!" and Steve was laughing, saying "Whoever answer the call, owns it!" Turns out it was nothing and Peggy said "See? Every time I answer the phone as me I end up with another BiPap. I answered as you and it was nothing!"

The Day crew must have thought we were all out to lunch but for such and awful night it sure was fun!

You Might Be A Respiratory Therapist If...

1.  You own at least three pens with the names of prescription meds on them.

2.  You wash your hands BEFORE you go to the bathroom even at home.

3.  You believe that any job where you can drive to work in your pajamas is a cool one.

4.  You've been exposed to so many x-rays you consider it a form of birth control.

5.  You've ever heard a patient with a nose ring, brow ring, and twelve earrings say "I'm afraid of needles" as you pick up their wrist.

6.  You've told a confused patient that your name is that of a co-worker and to call if they need help.

7.  You had no idea in RT school that you'd see so many naked people once you started working in the hospital.

8.  You believe that not all patients are annoying...some are unconscious.

9.  You family and friends refuse to watch medical sitcomes with you because you spend the whole time correcting everyone and point out the upside down x-rays.  (Glenna's comment: Why stop at sitcoms? What about dramas and movies?)

10.  You don't get excited about blood...unless it's your own.

11.  You understand that you can't cure stupid.

12.  You've sworn to have "Do not resuscitate" tattooed on your chest.

13.  Discussing body fluids and dismemberment over a gourmet meal seems perfectly normal to you.

14.  You believe in the aerial spraying of prozac and xanax.

15.  You believe that "shallow end of the gene pool" shoudl be a recognized diagnosis.

16.  You have ever wanted to write a book titled "Suicide: Getting it Right the First Time".

17.  You've ever had to leave a patient's room before you begin to laugh uncontrollably.

18.  You consider graham crackers and peanut butter stolen from the ward kitchen your lunch break.

19.  You believe there's a special place in hell for the inventor of the beeper.

20.  You've ever had a patient look you straight in the eye and tell you they quit smoking "a long time ago" while you're holding the ABG report that shows a CoHb of 7.

Qote of the Day/Cartoon

"Mistakes are painful when they happen, but years later a collection of mistakes is what is called experience." -- Denis Waitley

How Do You Handle Mistakes by Co-workers?

Bear in mind that it's 10am and I've officially been up for 24 hours.  Also know that I haven't gotten more than 4-5 hours of sleep a day in over a week.

So in that frame of mind, let me ask a question. How do you handle mistakes by coworkers when you find them? The reason I ask is because last night was, not horrible exactly, but insane.  I had Assess & Treat where I filled up TWO assignment pages with the exception of 4 lines on the second page.  It was all A&T's, Respiratory orders on charts, interventions with dropping sats, PRN Tx's, and I had both a Bipap of my own plus an order for a Bipap that, thanks to Lasix, never had to actually go ON the Bipap. In a twelve hour shift I went to the bathroom exactly ONE time.  I took exactly one 20 minute break in twelve hours to eat and chat with Kendall.

My last A&T was finished at 0620 and I went back to the department to update the final sheets with stickers and to double check them.

I was very tense at the end of the shift because it felt so  "maybe-ish".  I had tried to double check all my orders on the sheets. I had tried to double check all my orders on the charts and in the computer but I admit I was pulled away so many times from each task it was hard to keep everything straight. 

Besides the BiPap I also had a patient who was fluid overloaded that I ended up calling the doc on-call with all the info and the gas report because the nurse was young and nervous and a little overwhelmed.  I also had a COPD/Asthma exacerbation that was sooooo bad at first neither I nor the nurse could hear ANY breathsounds on.  We were both joyful when the patient started wheezing so we knew we were headed in the right direction.

In between running back and forth between those two and the BiPap, I knocked out a hell of a lot of A&T's.  Don't know exactly how many, just know I filled almost two pages with names. 

But you know what?  As I was walking out the door I realized that none of the good stuff really matters. It doesn't matter that I pushed for the fluid overloaded patient and took over the doc phone call from the nurse and probably saved that person a trip back to the unit. Doesn't matter that I busted my hump to work with that family. Doesn't matter that the house nursing supervisor told me and that nurse we did "everything you should have and more".  Doesn't matter that the nurse of the COPDer thanked me about a dozen times for being there with her, for checking back on her patient every half hour.  Doesn't matter that last Monday night I went out of my way to pull extra gases on two of my patients, even though I was up to my eyeballs in things to do, and fixed both of those PO2's. 

I'll never hear anything about those.

Come next Monday night when I walk back in the door what I will hear about is the O2 Order I'm terrified I forgot to write in the hard copy of a chart or any other of several mistakes I could have made. I always hear about the mistakes. Some of my co-workers are very good with a copier when they find my mistakes and make sure a supervisor "talks" to me.

Funny, I've never once photocopied anything and taken it to a supe.  Usually what I do is fix it if I can and move on.  Not saying I'm perfect but I don't go out of my way to get people in trouble either because I do like everyone I work with and I believe that we're all doing the best we can.  We're all human and we all make mistakes from time to time especially with the new charting system and the sheer volume of work we're doing.  I admit, though, I walked out the door this morning depressed as hell because there's no doubt in my mind that when I check my email and my mailbox come Monday someone will have found something I didn't chart right and will make sure a supervisor knows I screwed up. There was just too much work involved to be confident that I did every single thing right.