Endless Types of Impairment

This last week I had a patient to prepare for surgery who was blind in one eye and with significant vision loss in the other. He, and his wife, had come in a week earlier for his surgery interview.

It was there that the consents, surgical and anesthesia, were read to him before a large ‘X’ was placed a the signature line in order for him to navigate where to place his signature. At the bottom of the form the P.A.T nurse ( aka interview nurse) had written ‘ consents read to patient.’

Yesterday, the O.R. Nurse challenged this as being sufficient. Out of earshot, my simple response to her inquiry was ,” Hey, he’s alert and orientated, told me exactly what he is having done today. Actually a very articulate gentleman.”

She sought the input of her supervisor.

The supervisor came to our area and approached me. I stated that asking his wife to sign a durable power of attorney was diminishing to his intellect, awareness, and sensitivity as he was read every single risk to anesthesia – and there are fifteen listed at the top of our anesthesia consent forms. It’s a daunting read, whether you’re doing it yourself, or someone is reading the consent to you.

The supervisor took an alternate route and told me she wanted to first call Risk Management before he was allowed to go the O.R.

Risk management confirmed that what the P.A.T nurse did was appropriate.

I’ve never wanted this blog to be a place where I make habit of blasting leadership, the nursing profession, or my peers. In theory, calling Risk, not a bad thing, it’s a valuable department. But for this situation, it was, in my opinion, overkill.

And it pushed my buttons.

When you enter the hospital for treatment and sit first with someone in registration, I suspect that no one reads the whole financial statement form to you.

Just sign at the bottom.

After your insurance information is verified.

After it is know where to send all the bills.

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There are worse impairments than visual impairment.

And often they belong to everyone but the patients.

March Moment

“I don’t like needles.”

Twenty-one. Probably his first. Unless he’s donated blood.

“Thanks for letting me know. Most don’t. We use lidocaine. Just like at the dentist. It ‘ll make it less painful.”

“If it hurts at all, I’m going to punch someone.”

I waited to hear a laugh. No laugh.

Twenty-one. 6’4”. Long reach. Sculpted biceps.

Hmmm.

“I’ll be right back.”

brrinng brrinng

“Hello. Anesthesia. I have a patient that I need help with starting his IV.”

____________________

This is the only time I have bailed on a patient.

For All the Right Reasons

 

I photo bombed a patient trying to take a “selfie”, but it was for all the right reasons.

Now, I know what you’re thinking…there is no good reason to photobomb someone taking a “selfie”, but hospital selfies different. Let me explain.

First, anybody in a hospital gown, sans make-up or hair done, and lying in a bed, is unlikely to want their photo taken.

The process normally starts with the family or friends sitting around and wanting to lighten the mood. Conversation has come to a lull. The reality of why they are there is sobering, as sobering as all the risks listed on an anesthesia consent form. They all start commenting on the amazing beauty of the required blue net hair covering and the air-conditioned design on the back of the gown. There is deference to comments by the patient. She or he is the one actually going through the event of having a tube maneuvered down their throat and incisions made on their abdomen or other regions. The friends and family will get a one shot photo –op. Then the patient will get in on the ludicrous humor of it all and offer up their own choreographed photo for the people not in attendance; the Facebook and Instagram crowd

If I see a patient shrivel up when a visitor pulls out a camera, I’ll shake my head, give a halfhearted smile, and tell them everyone’s getting IVs if I hear a click or see a flash. I don’t have to do this often.

Now yesterday…my patient was alone.

She’d been dropped off – to be picked up at an estimated time based on her surgery schedule. She was quiet when she first arrived, but easily drawn into conversation. We had a good rapport while I listened to lung sounds, accessed a vein for her IV, and explained the pre-op medications.

It was when I stepped back to the wall mounted computer at the bay entrance that I noticed something.

Her smile had dropped. She fidgeted with the T.V — changed channels then turned it off. Reaching for the next mode of entertainment, I saw she now had her camera in her hand. All this time, I am filling in screens and toggling to the flow sheet.

I’d stepped over to print out a strip from the EKG monitor when she was angling the camera to take her selfie. It was easy to see that she wasn’t into it. There was no mock lip pursing or raised eyebrow. She hesitated then put the phone down. She picked up the phone twice but never smiled.

I don’t know what came over me, but the third time she picked up the phone and set it eight inches from her face, I stuck my mug in there right next to hers and said “You got this!” She took two photos.

Her laugh made my day.

 

Dream, Dream, Dream

I wonder if my patients dream during surgery.

I wonder if the last person they see pops up in their subconscious while their surgeon is cutting, suctioning, or fixing immovable joints and stenotic veins.

I wonder if anesthesia makes “sleep state” dreams more vivid, less vivid, or ominous in their meaning.

People seem to be less afraid of the anesthesia, and more of the cutting and alterations made while they “sleep”. That’s ironic to me, seeing as the incisions are portals to our pain —reminders of our presence here.

Anesthesia steals our time.

I’ve had patients again and again wake up post procedure with the confused look on their face because it feels like only minutes have passed when it has been over an hour. I’ve had recovery nurses tell me the confusion post-op patients feel makes them anxious and elevates their pressure.

It’s the only instance when I don’t sing the praises of anesthetics — when you encounter those that are sensitive to their time here, whether it’s blissful or complicated.

So I hope that when they must “sleep” on one of their visits to a surgery center or the surgical unit of a hospital, they dream.

And they remember it.

And it’s a good dream.

Working with Smurfs

Fun moment between me and a patient this morning- Did the best I could to jot it down so I could share !

I’m facing her; putting on her monitors. She’s looking in the periphery behind me.

She says, “Did you notice that your Anesthesia doctors look like Smurfs?”

I turn and glance. “Um, what do you mean?” As soon as I say it, I understood what she was referring to. It was the designated color of their agency scrubs. The periwinkle blue matched the skin tone of the comic characters perfectly.

I place the last lead. “Well, they’re really smart Smurfs.”

She countered with, “You know Smurfs love to eat Sasparilla.”

Me, “Ours eat lazy nurses.”

She, “But I see they’re not wearing hats.”

Me, “They put a new one on every time they go back through that door on the corner.”

She, “They put on Phrygian hats?”

I pause. She’s got me there.

She. “The cartoon, it’s based on an old Belgian story. My dad was an illustrator. He talked about cartoons a lot. That’s what the hats were called.”

She had me working parts of my brain usually allowed to rest during work hours. I printed out her EKG and started to step away from the stretcher.

“Susan, who’s the Smurf coming this way?”

“That’s Papa Smurf. You don’t get to leave the pre-op mushroom until you speak with him.”
She raised her eyebrows and gave me a mischievous grin .

My last words: “He was on call last night. Don’t tell him he looks like a Smurf.”