Pants?

Overheard on the unit:

The nurse says to patient walking around on the unit "Darling, are you a little cold? Because you forgot to put on your pants."

One of my patients recently told me how their aunt is blind, and her aunt's husband has Alzheimer's. They are totally dependent upon each other and times are starting to get tough due to his slow decline. He is the only one who can drive, and twice during the past 6 months he has been found by the police in his car with his wife--totally lost. He'll be driving down the same roads he has for the past 50 years and will suddenly forget how to get somewhere. The problem with this is that he refuses to admit he's lost, and since his wife is blind she can't help them out.

It's a terrible situation. The family is wrestling with the idea of taking the car and license away from him for the safety of them both. But by doing that they will be taking away their ability to leave their house independently.

It is a tough decision to decide when is time to intervene.

Travel Clinic

I just went to the travel clinic to prepare myself for the upcoming departure, and I must say I was very impressed. They had charts, maps, books, etc. on what I should take with me in order to prepare for this trip. I left with shots, the promise for more shots, and appropriate prescriptions to take along with me.

I know a lot of people go traveling, and I hope people are aware that such clinics exist to prepare and protect you for healthy travel.

One Laptop Per Child

For those who haven't heard about the quest some brilliant people at MIT are on to make a $100 laptop this is a site worth checking out: One Laptop Per Child

They are trying to insure that every school aged child in the world has their very own laptop. Imagine the educational offerings! Imagine the instant messaging.

Right now they are having a promotion where you and I are able to purchase one of these laptops. The cost is twice as much, and for your extra money you actually purchase another laptop that will be given away to a child in a developing nation. It's a win-win situation. The organization gets more exposure and gets to donate more laptops, and the purchaser/donor gets the latest tech gadget.

Vacuum Assisted Closure of Primary Wounds

We had an inservice today about vac dressings. For those not in the know it's a great way to cut healing time. Studies have shown that it can cut healing time by a third. It also lets people have less frequent dressing changes, which reduces the pain and discomfort patients often feel with the standard twice daily wet to dry dressing.

Often times these vacs are only used on wounds that have failed to close primarily. An example would be a surgical incision that has become infected and needs to be re-opened to allow to close secondarily.

I was surprised to hear today that there is talk about using vacuum assisted closure on primary closures from the beginning--before they become infected. This would be done by placing the vac right over the suture line.

I tried to do a quick google search to see what I could find about this with no luck. Does anybody have experience with it?

Sick Calls

Sick calls can be a killer on a unit.

I work in the kind of environment that is greatly affected by somebody being absent in the immediate time frame. If somebody isn't there when scheduled, it means that those who are there need to take on extra patients and responsibilities. If there is more than one sick call it can lead to the need to close beds on the unit as we don't have the nursing staff to take care of them, which will then affect the whole hospital and most importantly the OR and ED. One of the worst days I've had at work was when we had sick calls. I was in charge, and I had to tell admitting and the OR we didn't have the beds they desperately needed. This prompted one phone call from an occupied OR, "You mean to tell me that you honestly don't have a bed available? I have the patient on the table prepped and shaved! What am I supposed to do now! Send him home?" I told them I had no idea what to do. All I could tell them was that there was no room at the inn.

So how do you manage sick calls? People become ill, it's part of nature. How do you tell people that being ill too often is unacceptable? It's a tricky situation as people can't manage when their body becomes ill. But what do you do about the people who take advantage of calling in sick when they aren't? Or when they just don't want to put in the effort of finding alternate child care when the regular sitter falls through? Suggest using Parents In A Pinch for emergency childcare. Put out unit expectations for sick calls.

There has been some complaints about sick calls on my unit, and it has recently prompted a posting of unit expectations on sick calls with actual numbers as to how many times in a time period it is allowed. Now, they are not saying come to work when sick. They are just saying they are going to talk to you if it is looking suspicious or if you are excessively calling out. We'll see if it helps.

Map Of Doctors Of The World

I thought I'd share this interesting map of the world that shows the number of inhabitants per doctor. I wonder what the number is for the city of Boston.

http://thewvsr.com/doctors.htm

Blood Group O and Malaria

I'm starting to get prepared for my upcoming trip to Africa, and I must say I found this article quite interesting, especially since I fear Malaria and I have group O blood.

That leads me to pass on that my fellowship placement is finally all set! I'll be leaving for Zambia in January to spend 6 months there working on the Maternal Child Health Initiative being sponsored by the Massachusetts General Hospital Center for Global Health.

I will continue to keep posting on this blog about my experiences. I hope you will enjoy being an observer to my great adventure, and maybe even learn a thing or two.

Wish me luck!

Prisoner

I took care of a prisoner. It was strange closing the door on the room expecting complete privacy for the patient so you could care for her, but uncomfortable that this time two guards were watching your every move and not allowing any privacy. It was awkward waiting for the handcuffs to be removed and replaced anytime you wanted to help her walk or go to the bathroom. I couldn't help but feel she was a nice person, or at least polite and cooperative with me, even though she was a criminal that had landed herself in jail. I felt stupid when the guards stopped me from handing her the phone as her husband had called; I didn't realize that even the right to talk to loved ones was taken away in some respect.

I hope she felt that I cared for her as a human being who needed my aid, and not as a criminal.