A Review of Showtime’s Nurse Jackie

June 15, 2009
She Does What we Only Wish We Could Do to Some of our Patients

She Does What we Only Wish We Could Do to Some Patients

I recently watched the pilot episode of Showtime’s new show, “Nurse Jackie”, with the night crew. Jackie, played by Edie Falco, snorts crushed vicodin, steals money to give to the poor, forges an organ donor’s card, has sex on the job with the pharmacist who supplies her with the vicodin and flushes an arrogant jerk’s ear down the toilet after some choice words – and that’s just in the first episode.

In many ways – sex and drama aside – Nurse Jackie is the quintessential “take-no-crap” ER nurse that has served as an experienced den mother of sorts to so many young doctors and nurses still finding their way in the medical field. I still work with , and learn from, nurses like that, who continue to enlighten me with their experience, wisdom and knowledge. And no, I didn’t grab their boob or have sex with them in the supply room.   

On one hand, I fear that people will actually believe that nurses behave this way and treat them with even less respect.  I guess we will just have to leave it to shows like ER and Hawthorne to teach people to respect and admire the amazing efforts that nurses make to brighten, save and enrich so many lives on a daily basis in hospitals and clinics throughout the world. It is a noble profession that is too often the unsung hero. But back to the show …

Although it does present a flawed character portrayal of nurses, it is kinda fun to see someone act out what we all sometimes wish we could do with at least some of our patients. She has a distorted sense of ethics that leads her to do what will in the end be the most benefit to society in her opinion, and other times just gives people what we all know they really deserve. Except maybe her poor husband, but maybe the reasons for that will play out later.

From a doc’s perspective, I thought the whole Heimlich scene was coldly amusing. I get a similar feeling when responding to “Is there a doctor on the plane?”, because you really are never on vacation as a medical professional. It is a blessing, and sometimes it can be a drag, but no doubt it is wonderful to always be able to impact people’s lives – although not always in such dramatic fashion.

The nurses who watched it with me – male and female – enjoyed the show and were looking forward to future episodes. It presents an entertaining contrast to shows like ER and Grey’s where political correctness sets a border around the characters. So many of us in medicine hold back what we really think of some of the pathetic excuses for humanity that we see on such a regular basis from the the drug seekers, the self-righteous and those who feel they have the “right” to put us down, the domestic abusers who beat on their spouses, all the way down to child abusers and those who have children when they have no intention of doing anything remotely resembling parenting or loving, etc. It might just provide an outlet for those of us who bite our tongue and “do the right thing” even when it would feel so good to tell these people what we really think.

What I really want to know though is why the pharmacist has a bedroom in the hospital?

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When Funerals Go Bad

May 26, 2009

While at work yesterday, I overheard the ambulance going out to a call at a graveyard. Now, I personally like to give everyone at least one round of ACLS no matter how long they were down prior to arrival, but I think you have to draw the line somewhere right? In the end though, it turned out to be nothing. It did remind me though of one bizarre funeral that I received some clients from once while working in the South.

Family members had gathered for the funeral of someone who had died young. While the eulogy was being given, one of the deceased man’s brothers couldn’t contain his grief any longer and tore open the casket, dragging his dead brother out in front of the whole family so he could hold him. Needless to say, people started fainting, screaming, crying and the rest were just frozen in horror at the macabre proceedings.

I received two people via ambulance from this funeral with complaints of anxiety and fainting. Nothing a little bit of Ativan and a lot of counseling couldn’t handle though. I never did get to meet the hulk who ripped open the casket though. And that is a very good thing.

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The Origin of Swine Flu?

May 13, 2009

swine flu origin

I need to contact the CDC to track down this kid for isolation.

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Polypharmacy – Taking Too Many Medicines

April 30, 2009

One of the questions I get all too often from my patients, particularly the older ones who are way too many medications, is “Will this new medicine react with the ones I’m already taking?”

I answer by telling them, “Scientifically, we know how one medicine reacts with another. When you add a third one though, everything we know goes out the window. How about if you’re already on ten or more medicines?”

Sadly, many of our parents and grandparents, are on way too many medications. And this phenomenon has already trickled down into our generation and that of our children! I routinely see college students who are on 3-4 medications: an anti-depressant (seems like these are almost as universally used as aspirin used to be), an ADHD medicine (seems pretty standard for a lot of kids these days as well), birth control for many girls and then whatever variety of meds they may be on for asthma, allergies or other medical conditions. Our bodies have literally become pharmacies and then we wonder why we get so sick!

Statistically – especially for the providers out there – the likelihood of a patient complying with a regimen of medical treatment goes down by 50% when you reach four daily medicines. That means that half of your patients (who are on at least 4 meds) will be taking medicines not at all, haphazardly or in the wrong way out of confusion, forgetfulness or carelessness.

How to solve the problem? From a patient perspective, talk to your provider if you are concerned that you are on too many medications. See if there are any combination products that can help you lower the number of medicines that you are on. Secondly, remember that not every problem requires a pill or prescription. This is especially true when it comes to medications for depression. This is a serious subject though which I hope to write a proper post on soon.

From the provider perspective, remember to do no harm. Closely examine your patient’s medication list to make sure there are no redundancies – a very common occurrence. Also, try to help your patient’s find non-pharmacological ways to deal with their problems.

A friend sent me this great video made by Cafe of Life that probably says it better than I ever could – hope you like it as much as I did. Click here to watch.

Laying on of the Finger

April 29, 2009

healing_fingerPart of my mission with this blog is to help those outside of the medical realm to understand how much BS we often have to sift through in order to get to the bottom of things. Case in point, I get word that EMS is bringing in a potential “neurological injury”.

Let me tell you, neurology and nerve injuries are not on anyone’s list of favorite things to deal with in medicine. They’re confusing, complicated and then you have to deal with neurosurgeons – the medical equivalent of getting sodomized with a baseball bat. So, needless to say, I was worried.

Finally the patient rolls in, appropriately strapped to a spine board and in cervical precautions. He looks scared and worse yet, he’s not moving. He’s a young person, maybe in his mid 20’s, which makes it a recipe for true disaster. So, I carefully start getting the story.

Turns out that John and his girlfriend were having some fun at home and started chasing each other around the dinner table. But then suddenly John hits something and crashes to the ground, unable to feel anything below his waist. His girlfriend starts to panic and calls 911.

My first instinct was to get on the phone with neurosurgery, and get this guy into the right hands ASAP.  But the image of a baseball bat makes me think that I should at least do a thorough neurological exam on this guy first. I start with his cranial nerves, which seem normal above his waistline. Beyond that though, he has no pain response, no movement and no sensation whatsoever in his legs. I’m starting to sweat.

Last on the list though is to check rectal tone. When someone is truly paralyzed below the waist, they almost always lose their muscle tone in their anus and rectum, as well as losing control of their ability to control their bladder. Put simply, they urinate and defecate on themselves. Yet John’s tighty whity’s are Clorox clean. Hmmm? Maybe he was lucky enough to preserve this area I’m thinking. But, like it or not, I have to do the rectal exam.

As I start pulling his underwear down, for the first time it seems, John starts to look anxious. “What … what are you doing??!!”, he blurts out.

I explain, “I have to do a rectal exam … basically involves me putting my finger in your ass to check your muscle tone. It will help me to understand your degree of paralysis.” I have the nurse put the lubricant on my finger and just as my cool, gloved finger touches his anus, something miraculous happens.

John’s butt cheeks clench so tight, and his previously “paralyzed” legs snap shut and come off the backboard with truly impressive force.

So all was well in the ER. I wasn’t going to get sodomized by neurosurgery after all, John had a “miraculous” recovery and I temporarily became known around the ER as “Jesus”.

What had happened? I will never know for sure, but I’m pretty sure John was alright before EMS even arrived to his house. How far could this ruse have gone? Who knows? Why was he faking it? The promise of a disability check, for sympathy, thought it would be a good joke – your guess is as good as mine, but he wasn’t the first and he unfortunately won’t be the last person trying to pull the wool over our eyes for some alterior motive.

The Bottle’s Been Going Down

April 27, 2009

liquor_lockAlcohol. Too many stories, hard to know where to start. I have so many things to say about alcohol, but too tired at the end of this shift to start. But I think you might enjoy this little tale from today’s smorgasboard of delinquents.

Ms. Weetod, someone I have come to know very well, comes in today with her parents for uncontrollable nausea and vomiting. Usually these patients, the ones with uncontrollable nausea and vomiting, are snacking on chips and drinking a soda (or like Nurse K’s patient – eating a double cheeseburger) , but not Ms. Weetod. She’s 45 and living with Mom and Dad because she sunk her life down the toilet with all the liquor she’s had all her life. I saw her last week when she had a seizure in Wal-mart and she told me that she hadn’t drank for a month, that she was cleaning up her act. That’s what you might call confabulation (the replacement of a gap in a person’s memory by a lie that he or she believes to be true).

So today her parents tell me that they are “very concerned” about her vomiting and that she must be very sick. Now I don’t ever drink and have never gone to a bar, so I usually have a tough time with the smell of alcohol on a person’s breath. But after she breathed in my general direction,  I was already feeling a little lightheaded. But the parents said that she couldn’t have been drinking. So, I decided to check an alcohol level in addition to all the other usual suspects.

Low and behold, her EtOH level comes back at about .360 – close to five times the legal limit depending on what state you’re in for those who are unfamiliar with alcohol readings. Now I personally would have probably been dead at .30, and rigor mortis at .35. Granted this is not the highest I have ever seen – I think that would be .460 in someone who also remarkably happened to be awake. The human interest side of this story is not the height of her alcohol level, but the poor gullable people she was living with these days – good old Mom and Dad.

Knowing that I would be shattering their hopes, I bravely walked into the room. She immediately told me, “I feel so sick!” I couldn’t help it and replied, “Maybe you should stop hitting the alcohol.” Dad – with a look of shock on his face – says, “Alcohol? Where are you getting it from?” She tries to lie and says nowhere, so I casually mentioned how her alcohol level was enough to snocker everyone else in the room. Then Dad comes out with his classic, never-will-forget-this-one remark that showed just how honest and innocent this Mid-west couple was. He says:

So that’s why my bottle has been going down! (meaning the level of alcohol in his bottles had been mysteriously decreasing over the past few days) 

I’m not sure if he thought it was evaporating or what exactly?  But I didn’t have the heart to tell the old guy that not only was the bottle level going down, but that in reality, he was probably missing a few bottles at that. The awesome nurse that discharged him told them what they needed to hear though by saying that they needed to get rid of all the alcohol in the house. Guess I don’t need to tell you though about the dirty look she got from our dear Ms. Weetod who was clearly unhappy that we were getting into her private goldmine. Either that, or Dad needs to put a lock on his liquor.

Internet Date Goes Horribly Wrong

April 23, 2009

You're hot An interesting thing happened last weekend. My own Romeo and Juliette … from Hell that is.  We had two patients come in from a car accident by EMS. Here is their story; a story that deserves a movie deal, or at least a Saturday Night Live skit.

John and Peggy.

John, a portly 275lb, unemployed alcoholic was looking for love. But unfortunately, love wasn’t look back in his direction. So he tried the internet. Peggy, an equally portly 255lb, gainfully employed assistant manager was having trouble finding the right man and also thought to try her luck on the internet. It was a match made in heaven, or at least in Heaven-Hill.

Their love on-line seemed to blossom, until they could hold themselves back no longer and just had to meet. John unfortunately had a suspended license (damn DUI’s), so Peggy would have to go and pick him up. They decided to go someplace exotic, someplace intriguing, a place where they could look deep into each other’s eyes and hear one another’s sweet words. They decided to go to a bar.

At the bar, they drank and drank. Maybe they imagined that the alcohol would make them appear more enticing (ahh, the famed beer goggle).

They hoped for the arrows of Cupid to pierce deeply into their hearts, but instead they discovered that the alcohol only brought on the spear of Ares (Roman god of war). Their arguments led them to decide that maybe it was best to go home. But Peggy was nice enough to at least drive the drunk and stupid John home.  John, alcohol having removed his ever so thin veil of “niceness”, told Peggy she needed to take a certain route to get him home.

Peggy, on the other hand, thought that John’s liquor was talking instead of his “brain”, and she decided to take another road to get him back to his hometown. I guess her route would have eventually gotten him home if they had driven long enough in such a great circle, but we will never know the answer to that intriguing question. Why?

Because poor John became so angry at his dear Peggy on their way home, that he decided to grab the steering wheel at 50 mph and spin it around. He apparently thought that this would be a good idea and help put her on the “right road” as he tells it. Unfortunately for our dear couple, the car rolled and landed in a ditch awaiting the fine men and women of EMS.

Upon arriving, EMS immediately recognized that they were in the middle of a love nest and decided to transport our  Romeo and Juliette together in the same ambulance. Although it sounded to everyone else like they were arguing and blaming each other, as well as calling each other @$%&*# and the ever-endearing ?*&$%#!, I’m sure that this was just John and Peggy’s own special love code. We on the other hand in the ED had to give them separate rooms. That didn’t stop them from yelling at each other across the hall though. Oh no, love like that just can’t be stopped.

They were both drunk – John weighing in at an alcohol level of .31 and Peggy (the driver) coming in a close second with a .20. State Police was present to give them citations by which they could immortalize their first date. Who knows, maybe they may even consider tying the knot when they show up for their court date. Although some may see Peggy losing her license for drinking and driving as a tragedy, my sentimental side sees it as an opportunity for them to take long, romantic walks along the highway together.

At the end of it all, it turns out that even though John was chomping at the bit to leave and get out of his spine precautions, the poor soul had suffered a broken neck. Yep, a good old C2 fracture. It would be a wonderful reminder of his first date with Peggy. Peggy would only end up with a few scrapes and bruises to remind her of their first meeting though. Ahh, a first date to remember. Just hope I’m not around for their next one!


* Note – a case like this illustrates the great importance of radiographically clearing a C-spine when you are dealing with an intoxicated patient. Don’t be misled by their lack of pain and get a good radiographic exam.