Monday, 2 May 2011

Through Bile-Stained Glasses

Today, Jeff Gonsalves, registered nurse and author extraordinaire, joins us. He works in pediatrics in a large metropolitan hospital in California and has worked with kids for over twelve years. He has assumed many roles: a busboy who clears the meal trays from your room, a WWF wrestler who clinches psychotic teens in a bear hug when they try to assault me, and an engineer who tries to solder wires together and ends up creating an open circuit through his heart's left ventricle. He has a completely different viewpoint than what we normally get. His experiences in hospitals influences his writing.

Let's give him a warm welcome.

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As you can see, I'm a Jack of All Trades. Forget nursing duties. They come second. I can give blood transfusions, hang chemotherapy, and untangle dialysis hoses, but my most valuable skill is successfully hooking up an XBox. Am I an Angel of Mercy? Highly doubtful. If I am, someone sliced off my wings and stashed them in a refrigerated drawer in the basement morgue.

I relish my job. Working with children is a singularly rewarding experience. They want to play and have fun and I love them for it. Rarely do I have a problem with patients. My pet peeves stem from adult ignorance. Medical care has come a long way in the last decade. Quality care is a given, as it should be. Now people are more concerned about the amenities. Who cares if the doctor saved my baby's life, the ICU doesn't have a frigging Blu-Ray player and the fish tacos taste like Chicken of the Sea!

Compiled is a list of "Situations" that have rankled me over the years. Many of my co-workers share these grievances, and although I make light of them, often times they cause enough stress to make me consider throttling myself with a urinary catheter.

Situation One: Obsessing over ID bands: Name bands are undeniably important. They reduce medication errors and give parents peace of mind. But when I've taken care of a patient twenty times in the last month, I don't need to look at his bracelet to ascertain his identity. Unless he has a biological twin or his soul has trans-migrated into another body, I can recall who he is. This is especially true when I have to give ten medications throughout the night. Most patients need sleep, and if I yank his wrist out from under the blankets a dozen times, he'd probably prefer me hacking off his arm with a bone saw and duct-taping it to the side rail so I don't have to wake him up every half hour.

Situation Two: Inappropriate Doctor Calls: Yes, your baby is fussy. Yes, he probably has gas. Yes, colic is the root of all evil. But sorry, I'm not going to call Dr. Jones at 3:00 a.m. to get an order for Gas-X. A few pats on the back are probably more effective than a medication that pops air bubbles. Dr. Jones needs his sleep, and he'll be more effective treating your child the next day if he isn't awakened because of an infant's absent belch-reflex.

Situation Three: Tangential Illnesses: I get called into room 647B. "My daughter's poop is bloody!" a mother screams. "Something is deathly wrong!"

"Hmmm," I reflect profoundly. The ten year-old girl is here for a dental abscess. I scan the toilet water. Indeed, the bowel movement glows a bright crimson. Next to the bed is a table clustered with fruit punch Gatorades. The red dye could permanently discolor a white shag carpet. Returning to the girl, I find her in tears. I try to calm her down, explaining that a tooth infection doesn't cause spontaneous intestinal hemorrhaging.

Situation Four: Scorched Alveoli: No, I'm not talking about a burnt dinner entree. We're talking charred lung tissue, here! A four year-old needs a chest X-ray to rule out pneumonia. The father is angry, complaining that exposing his son to radiation is dangerous. I reply that the amount of radiation used is quite safe. "Then why do I have to wear a metal-plated vest?" he yells. By now, the son is horrified. "Daddy, don't let them fry my lungs!" he sobs. I explain that the X-ray machine is not an incinerator, nor will it convert his pleural cavity into an impromptu crematorium. By the time the father agrees to the procedure, his son has to be sedated with IV Valium because he's afraid the machine will "sunburn his insides".

Situation Five: Engorged Dumpsters: Hospitals probably discard enough food to feed ten Third World countries for a year. So please make sure your child is going to eat that specially-ordered fruit tray. When it arrives from the cafeteria, and your child pokes at it with a finger, then declares, "I'm not hungry anymore," I feel my bile rising. Especially when the parent leaves and returns with a bag of Doritos or Reeses' Pieces, which the child promptly devours. If you don't think your child will eat it, please don't order it. But if you do, leave the cellophane wrapping intact. That way I know it hasn't been coughed on and I can sneak it off the meal cart later and eat it for my midnight snack.

Situation Six: Chuck Norris-in-Training: Another RN role is resident punching bag. I've been spit on, punched, kicked, and eyeball-gouged. Most parents are good about limit-setting, but others say, "Honey, don't hurt the nurse." To which the kid smiles and tries to connect with greater force. The mother smiles helplessly and shrugs. One night a lady actually said, "Don't hit him in the face, darling. That's painful. Hit him somewhere else." Glad I brought my athletic cup. Often I have to be the bad guy, and discipline the child, which is awkward at best. I understand the hospital is a stressful place, but just because your child's sick doesn't mean he can break my nose.

Situation Seven: Magical Thinking: I've been starting IVs for thirteen years. It's a precise art. Some kids are easy, some near impossible. Searching for a vein under a toddler's chunk can be like finding a needle in a haystack. I can't see it, feel it, or decipher whether the vessel curves or has one-way valves. Couple this with trying to restrain a two year-old who is hysterical, and the IV-starting process becomes a nightmare. Still, many dads will say, "It's okay, bud. He'll get it on the first try." This is compounded by a grim stare that implies, "You'd better not dig around or miss."

This drives me nuts. By saying this, he's making a liar of himself if I can't start the IV. It also makes me look incompetent if I can't accomplish something that's extremely difficult. His naive declaration has increased his child's stress by decreasing his trust in me. But still he keeps saying, "He'll get it this time, or else," and I keep jabbing with the needle, trying to jimmy it into a vein the size of a hair strand. When it finally slides in, proving that miracles do happen, my relief is withered by the dad's obstinate grumbling that "The IV people here suck."

Situation Eight: Knowledge Deficit: Remember that nasal swab? How could you forget the way your toddler shrieked when a nurse shoved a wiry Q-tip down his nostril? Well, the result was conclusive: your child has parainfluenza virus. This means that the respiratory illness is viral in origin, not bacterial. In other words, antibiotics won't help.

Antibiotics work by puncturing a hole in the bacterial cell wall, causing the ectoplasm to seep out like a microscopic egg yolk. Viruses don't have cell walls. They have a completely different structure that is unaffected by antibiotics. So just because your child has a runny nose, cough, and sore throat, doesn't mean antibiotics will magically cure him. Overuse of penicillin and gentamycin leads to bacterial resistance, and soon a super-germ will arise that cuts through the populace like a Reaper's scythe. Standard treatments will prove obsolete, and a terrible epidemic will plague the world like the second coming of the Bubonic Plague. Then again, who knows, maybe the dreadful bacterium will be killed off by antiviral medications!

Situation Nine: Incompatible Roommates: The call light beeps. I grumble that I'm not a man-servant, then flash my most charming smile and hustle down to the room. Inside, a Middle Eastern man is saying his morning prayers while facing Mecca.

Oh no, I think. This is pool of gasoline awaiting an open flame. The mother next door complains that the man's "chanting" is waking up her son. Can't he go somewhere else?

The man is irate now. How dare she take away his religious freedom! A flurry of insults follows.

"He has bad B.O."

"She is a disrespectful wench."

"He looks like a Gypsy and might steal my purse."

"She makes funny grunting noises and maybe needs laxative."

I ask the man to perhaps pray elsewhere, or quieter, and he refuses, citing that the woman is a racist. She starts crying and hurries outside, leaving her ten year-old son alone in the room. He appears to be sleeping soundly.

Outside, the lady whispers that the man was speaking on the phone in a different language. She suspects he may be a terrorist. It's probably wise to get security involved. I explain that she is jumping to conclusions, and I can't call the police on a wild hunch. She rushes back into the room in case the man is harassing her son. A screaming match ensues. Now patients in adjacent rooms can't sleep, awakened by a barrage of insults.

I move the woman to a different room. This disturbs the family trying to sleep next door. After thirty minutes, the woman emerges, complaining that her neighbor "snores too loud." She demands another room. I'm tempted to move her into the utility closet. During her two-day admission, she is moved five times, always because her roommates are unacceptable.

Some folks simply aren't compatible. Others will trump up any excuse to get a room to themselves. The solution is to always move the problem family. Unfortunately, this causes collateral damage. If I had my way, I would move the patient into a comfortable room, then explain to the mother that visiting hours were over two hours ago. A nationwide study concludes that she would be much happier at home in her own bed.

Despite these frustrations, I genuinely enjoy working on the pediatric unit. The majority of families are wonderful. Human conflict is inevitable, and it keeps me on my toes. Rarely is my job boring or monotonous. Just the other day, a cute, funny kid wanted me to cook his microwave popcorn, tickle him until he howled with laughter, put a new dressing on his abdominal wound, and fix his unresponsive iPod. If I had been solely an Angel of Mercy, I couldn't have accomplished all this. And besides, the kid probably would have torn off my wings and used my halo as a basketball hoop.

I guess I wouldn't want it any other way.

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When he's not guest blogging here, he can be found at his website, on Facebook, Twitter, and his blog. You can view the trailers for Fork in the Road to Apocalypse: A Subnorm Novel on YouTube.


Elliott Andersson is a disturbed young boy with a dangerous psychic talent. His mother believes that he can make a victim's worst fears materialize in times of stress, so she keeps him locked in her house for days at a time. In a fit of desperation, Elliott transforms her home into a fiery vision from Hell, drawing the government's attention. A frantic chase results in the crippling of federal agents and detainment of Elliott in a maximum-security seclusion tank.

Elliott's uncle Chuck is an operative working for the Genetics Bureau, the agency that has subdued his nephew. His job is to interrogate mutants to see if they possess lethal psychic abilities. When Elliott is imprisoned, Chuck embarks on a moral roller-coaster ride, uncertain whether to protect his nephew or society. His nonchalant attitude masks an innate desire to save Elliott at all costs--even if it means leaving casualties in their wake.

An interrogation proves that he can alter reality, and the government decides to evaluate Elliott for use in military combat. Frightened, but with a strong will to survive, he resists the hands twisting him into a weapon. He is reeling on the brink of despair when his uncle forms a band of renegade soldiers to smuggle Elliott out of the Genetics Bureau.

After this daring escape attempt, Chuck and a group of aberrants board a skim-cruiser headed into an uncharted wasteland. Pursued by the military, an android stalker, and a vengeful government agent, their only hope is to reach a leper colony that may not exist.

Shadowing every victory is the suspicion that Elliott cannot control his psychic ability, and is unconsciously using it against the people he loves most.

Chuck must determine whether Elliott can be saved, or whether his psychic ability must result in his own termination. But at whose hands?

I arrived at my sister's duplex in ten minutes. Elliott's agenda had detonated like a nuclear warhead, laying everything to waste. The lawn had been replaced by a volcanic ulcer of lava, neon orange and rippling sideways. Steam sprayed out of the fire hydrant, hovering in a scalding fog over the magma. The driveway was scorched black, paved with charred cinderblocks. His illusions seemed so realistic I found myself stumbling back even after a sludgy wave of lava failed to scorch my shoe.

Ash coated the roof, as if dozens of corpses had been cremated there. Withered trees trailed smoke into the sky. Flowers in the garden became hands clutching fistfuls of air, their wrists submerged in mud. Scarlet light spilled out the windows as though the duplex had been converted into a forge.

Perhaps the most striking feature was a monstrous, forked tongue protruding beneath the garage door, flailing like a bullwhip.

Elliott's doomed, I thought, reeling on the threshold of Hades.

The air around the house was hazy, singed by heat. The odor reminded me of burnt waffles, which is what Velma had told Elliott "Hell smelled like". Amazingly, my nephew was now capable of olfactory hallucinations. He could produce scents to accompany his illusions.

Defying his horrific mirage, I tiptoed across the lava, greasy fumes puffing up to liquefy my vision. Tortured banshees wailed in my ears, hinting at condemned souls torn apart in the netherworld. With each step, chunks of scree belched up and became stepping stones so I wouldn't plunge into the inferno. On the other side, a sooty beach washed up to the front door. The sand was littered with razored shells waiting to mutilate my feet. A raven perched on the duplex's gutter, a lock of Elliott's hair pinched in its beak. Beside it rested a nest made of bones, its pink, squalling bird fetuses eaten alive by maggots.

The living room, too, had been warped by Elliott's raging psyche. Contrasting the childish panorama of Hell, it was transformed into a mortuary. The windows were colorful stained glass, fashioned with images you would see inside a church. The brown carpet was now a plush purple, the sour odor replaced by incense. A flickering TV flashed images of veiled widows mourning the deceased. Watching them turn to face the screen, their faces were identical. Each bore the stern countenance of Ms Horner, a schoolteacher who disliked Elliott because he was an "aberration". Organ music groaned from a radio, casting a pall over everything.

In the center of the living room sat a coffin on an oval dais, a red satin cloth drawn over the casket. Massive holes had been gouged in the lid, the way Elliott might render a plastic box containing his pet lizard.

Chilled, I stepped forward and heaved open the lid. Inside, Velma lay cloaked in her wedding gown, a frilly, white, moth-eaten dress. Shovelfuls of dirt smudged the gown, as though gravediggers had tried to bury her with the coffin unsealed.

Velma's hands were crossed over her chest, clutching a vidpager. She gazed up at me through jittery eyelids. Her face looked grisly, powdered with mortician's attar.

"I can't move," she sobbed.

"Shhh, take it easy." Tears crept down her cheeks. "What happened?"

"Elliott got mad because I wouldn't let him play with a neighbor boy. He created the burning bush, and I told him to stop. He threw a tantrum, screaming that he was a bad boy and was going to Hell."

"Where's Elliott now?"

"A military patrol came by and saw my lawn on fire, so they smashed down the door. Elliott slipped out the back. He jumped on his bike and tore off down the road."

"He'll be okay, sis."

"The guards had rifles."

"They won't hurt him. They're instructed to contain a juvenile, not gun him down."

"I'm afraid I'll never see him again, Chuck."

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Fork in the Road to Apocalypse: A Subnorm Novel is available at link:, Wild Child Publishing, and OmniLit.


Faith said...

It's always that tiny handful who keep us on our toes, isn't it? LOL!

Great blog post!

Toni V.S. said...

Glad to say I was a "good" mother when my son was a patient. This was a most eloquent and entertaining blog.

Anthology Authors said...

Much to our dismay, we've been in the ER more times than we would like. We were fortunate to always have a private room, and we did our best to be "easy" parents.

It's always the few, Faith. They ruin everything. It's too bad we can't put them on an island with each other and force them to learn people skills. Now that woud be an interesting experiment, and save untold aggravation for the rest of us. (grin)

Faith said...

I enjoyed Jeff's post, tho. It's nice to see the medical help's side of things. However, I have a question for him.

How do you feel, Jeff, when you encounter a really callous doctor who treats patients like they have no feelings? Or have you met one like that yet?

Jeff LoSsOfReAliTy Gonsalves said...

Hi Faith,
Callous doctors are a dime a dozen. Thus, you treat them as if they're worth ten cents and request a different doctor. In the hospital, you have the right to get a second opinion or refuse an uncaring doctor. Luckily, in pediatrics the majority of doctors are caring and good-hearted. The few who are jerks amass a variety of complaints and are disciplined by administration. Unfortunately, they often take out their anger/insecurities on other staff. Thank you for the question!

Faith said...

You might've read it on our blog, but I took my son to the ER one night because he was coughing so hard he couldn't catch his breath. The ER was empty 'cept for us. However, the doctor spent 90% of the three hours we were there in the lounge. Boy, were the nurses mad at him!

Jeff LoSsOfReAliTy Gonsalves said...

Thanks, Toni. Probably 95% of the families I work with are wonderful. In my thirteen years as a nurse, I can only think of a handful who were difficult, and usually they made everyone miserable. I respect and admire parents who second-guess medical care and challenge nurses/doctors, as long as they do it in the best interests of their children, and without being cruel, abusive, or overtly homicidal.

Jeff LoSsOfReAliTy Gonsalves said...

Faith--yes, I am not surprised. I remember one night a child was in pain and the parents accused the doctor of eating chocolate cake instead of writing orders for morphine. I did a breath-o-lizer test and indeed found traces of cocoa on his breath!

Jeff LoSsOfReAliTy Gonsalves said...

Marci, thank you for the comment. Nurses and doctors are far from perfect, and are often in the wrong. Private rooms are the ideal, and when I'm the unit charge, I try to give everyone a private room. When we get jam-packed during the winter, however, it's just impossible. Then we have to put patients with similar symptoms together, and I often get complaints that children might get "double-pneumonia".

Larry Payne said...

Jeff, I feel your pain. I've worked healthcare for over 40 years. At one time or another every job encounters their own form of "Pull your hair out" situations. I finally had to resort to becoming a Monitor Tech, because I was running out of hair.
Hang in there,brother. I found out that every once in a while you get that handshake or that pat on the back and the "Thank You for doing a good job" and it suddenly makes eveything worth while and easier to handle.

Janice said...

I enjoyed the post. One of my daughter's friends is going to be a nurse, for I think, valley children's hospital. She volunteers there.


Jeff LoSsOfReAliTy Gonsalves said...

Thanks, Larry. Yes, I've pulled out all my own hair, plus clumps of hair from a few toupees! Seriously, though, I love the parents and kids. I've found I don't need verbal appreciation anymore--simply having kids ask if I'll be back the next night and then smiling when I am is fulfilling for me. I think pediatrics is an entirely different animal--the fun personalities of the kids often balances out any negativity from the parents.

Jeff LoSsOfReAliTy Gonsalves said...

Thank you, Janice. Nursing is a great profession, but it constantly throws curveballs at you. Just a couple weeks ago, a patient nearly stopped breathing because her lungs were full of fluid. Situations like this can definitely lead to anxiety attacks among RNs!

Starfox Howl said...

Any time you're in a 'customer care' position, you run in to the customer/parents/patients from hell. Glad to know you've survived and just think of how many of your 'from hell' situations you can use as the basis for scenes and characters. :-)

Anthology Authors said...

The last time we were in the ER was over a year ago. DD had a seizure, but she'd stopped by the time we arrived. Just to be sure, they insisted on jacking her up with (I can't think of what it's called). I wondered if she needed it, but went along with it. This was around 1-2 am. At 7 am, they are pushing us to wake her up so they can have the room. I understand, but whenever they've jacked her up in the past, she will literally sleep until noon. We got her awake, but they wanted her to drink milk without throwing up. Well, that medication makes her queasy. We tried giving her milk, but, of course, she threw it up. So I let her sleep a few hours longer. They were irritated with us. I do understand, but those seizures, and medication, take a lot out of her. Her body needs time to heal.

For the most part, the ER staff has been very, very good. It was just this one instance where they failed.

Thankfully, she's been seizure free since last April. We suspect she's done with it. :)

And we do question. Since she's been without a seizure so long, we have asked her neurologist whether we can try to ween her off of the medication. (She's on a very low dose for her age and size. I believe he hasn't tried already because of liability. Considering the litigious nature of our society, I don't blame him, but I'm still keen on getting her off this drug. :) )

Jeff LoSsOfReAliTy Gonsalves said...

Marci--they probably gave her a loading dose of phenobarbital or dilantin. Both very strong anti-convulsants. ER doctors do this to quash the possibility of patients having recurrent seizures. Then they typically order IV Ativan or rectal Valium for breathrough seizures. Dilantin and phenobarb are both very sedating because they suppress brain electrical activity. Were they trying to discharge you quickly? Where I work, most kids are admitted at least overnight when they have a potent seizure, either for a follow-up EEG or re-adjustment of their medications. I'm surprised they insisted on milk. Usually being able to hold down pedialyte or juice is just fine. But all ER doctors are a bit different in their approach.
I'm glad she's been seizure-free. A seizure disorder is very tough to live with.

Molly Daniels said...

I guess being raised by an RN has helped me with my kids' medical needs! A few months ago, I was in the ER waiting room when a mom brought her young child in 'because she vomited'. Okay....the kid looks fine now! So why drag her down at 11pm to the ER? And while they're waiting to get in, the kid is running around, all smiles. No sign of projectile or reocurring vomiting. And they are in and out before my family member with a potentially broken ankle is...and when they leave, the kid is asking for ice cream. Sheesh! Waste of time and money, imho!

Laurann Dohner said...

Hi Jeff,

I just wanted to thank you for being a nurse. I was diagnosed with placenta praevia at ten weeks into my pregnancy when I suffered a massive bleed, spent the rest of my pregnancy on total bed rest, but hemorrhaged at 32 weeks, and my son had to be taken emergency C-section. He suffered a brain bleed, spent his first week on life support, had his lung collapse twice, and spent the first month of his life in NICU. The nurses were AMAZING. The doctors and nurses saved his life more than a few times. They even allowed me to break the rules by allowing me to see him hours after his birth because I was still getting blood transfusions since I had to be given 6 units of blood and 4 units of plasma. They didn't have to find me a wheelchair and take me in there with blood bags still attached but they did it anyway. LOL. They held my hand when he took turns for the worse, kept me strong when we waited to see how extensive his brain bleed had been, cheered with me when he grew stronger, and allowed me to hold some of the babies who had been abandoned by parents too overwhelmed with their own children's medical problems when I wasn't able to hold my son. We spent a LOT of time in hospitals, getting tests, and after years of physical therapy and support through all the issues he needed to overcome...he's 6 now and healthy. He's in the first grade.

The wonderful nurses made all the difference. I know it can be a thankless job, some parents need slapped, but as a parent who greatly appreciated every kind word, every caring gesture, and the intense care given to my son when he needed it, I wanted you thank you for sticking in there. Nurses can make a WORLD of difference.

Jeff LoSsOfReAliTy Gonsalves said...

Hi Molly,
Yes, this is a source of frustration for ER staff, who are often overwhelmed with patients because people are treating the ER like a doctor's office or clinic. People wait until the last minute and go to the ER with problems they could have resolved earlier with their pediatrician/primary. This could possibly be due to insurance issues. The ER is forced to evaluate every patient that enters the facility, and that's why waiting times are so long--kids who vomit once have to have bloodwowk, fluid challenges, etc. Fast tracks have been set up at my hospital to discharge healthy patients more quickly.

Jeff LoSsOfReAliTy Gonsalves said...

Thank you for the kind words. I'm happy your son is thriving. I'm also glad you had a positive hospital experience. Working with sick kids/babies is difficult, but if people really become nurses for the right reasons, all the frustrations/challenges enrich them in the long run.

Becca Dale said...

Aren't parents fun? Great examples of how not to behave, Jeff. I fortunately had pretty healthy kids, but I must say the nurses and pediatricians/emergency staff were always kind when we did need them - a blessing of first order. The two worse situations - the poor nurse who could not get my newborn son to bleed when she was taking a jaundice test and the sweet young intern who stitched my daughter's chin together for the second time in as many weeks. Rough days for all involved. Glad you can use writing to escape a bit. :-D

Jeff LoSsOfReAliTy Gonsalves said...

Hi Becca. I'm glad you're experiences in the ER were positive. It's stressful enough having a sick child, so you don't need the added frustration of having rude and/or incompetant nurses/doctors.