My acceptance speech

I’m deliberately not watching the news today, as the phrase “Our…” as in “Our Nicole”, “Our Kylie”, etc makes me want to puke. I could do without the queasy feeling that will come with hearing “Our Heath” over and over again in reference to Heath Ledger’s posthumous Oscar win.

Despite all the hype of the Oscars, another awards ceremony has taken place; and I have been honoured with winning the inaugural 2009 Australian Medical Blog Award.

There are a few thank yous that need to be made.

Firstly, thank you to everyone that voted for prn penguin. It’s a strange feeling to realise that people actually read what I write. After being inspired by ImpactED Nurse, I had originally started writing simply as an exercise in reflective practice, with no expectation of any audience.

Thanks also to DrCris at AppleQuack for putting the whole awards thing together.

Finally a thank you to the other medical bloggers out there. This award process has opened my eyes to a few Australian blogs that I was unaware of. Now I’ve seen some pretty self-indulgent, crappy blogs before – honestly, who gives a rat’s arse about your back porch renovations – but there are some great health blogs out there. Some offer humour. Some offer education. Some offer insight. I personally enjoy the ones that offer all three.

So in celebration of my glorious victory, I’d like to turn the spotlight on what I consider to be some of the best bits from my fellow Australian health bloggers.

ImpactED Nurse
My favourite blog, and what I personally consider to be the best medical blog in Australia. Yeah… if there were an ImpactED Nurse fan group on Facebook, I would have probably joined… Some of the best bits:

How to be a nurse – this is quite simply essential reading for any nursing student and any nurse. I make sure that any student that I work with gets a copy of this.
Zen & the Art of Cannulation – if you’re learning how to cannulate then read this. It certainly helped me out.
The Prank – funny as.
Little Old Man – a poignant reminder that every patient we care for is a person who is (almost always) loved by someone.

The Dragonfly Initiative
This one is written by a medical student. Some of her pearls are:

Medical Quote of the Day #14 – I can sooo relate to this one.
Emergency deconstructed – An insight into working in ED.
How to interpret medical letters – Chuckles galore – what we write and what we mean can be two different things…

Outback Ambo
I’ve got a lot of respect for ambos – this one is a Territorian:

Abdo Pain – sometimes people don’t suspect the obvious.
Empathy – drug addicts are people too.

Aeqanimitas
Critical care & toxicology. There’s lots of interesting stuff here, especially if you are interested in jellyfish and other marine nasties. I personally can’t go past A picture worth a thousand words… VI
It just tickles my fancy in a way that keeps me smiling.

Degranulated
A timely story about a youngster’s introduction to the world of medicine. Timely in the sense that a patient of mine was grossly O-sign positive the other night. When the docs asked me how he was, I let them know. I was advised to notify them if he became Q-sign positive. I instantly thought of Degrannulated’s post…

Life in the Fast Lane
I’m a visual person. I like pictures. This ED doc’s blog has some quite interesting articles, but I can’t go past the imagery:

Radiological Oddity #6
ECG Library

Nurse in Australia
I only discovered this one the other day. Check out:

Watching a patient die
Public perceptions of nursing – sounds so familiar

And finally, I offer what I consider to be my better posts:

Don’t Panic! How to survive your prac placement as a nursing student – basically what I used to tell my students when they were undertaking prac.
The Odd Couple – One of the nicest things that I’ve ever seen a patient (well, 2 patients) do
Most embarrassing moment ever – I will never forget this lady as long as I live…

So thanks for reading and thanks for voting. I hope I can continue to write something worth reading, and hopefully make it look more presentable with my award prize.

Healthy changes are hard to make

It’s the same story, over and over again. Someone is admitted to hospital. They have abused their body for years. They are broken. And they and their families expect us to fix them and magically undo the damage that years of neglect have caused (or at least majorly contributed to).

The obvious examples are the smokers who come in with cancer, or with problems breathing; the alcoholic who has smashed their liver or pancreas; and the DKA admission who does nothing to manage their diabetes and continues to chug full-strength Coke by the litre. Or the 160kg patient who requires a bariatric bed and 6 people to roll them, who’se normal diet would make Morgan Spurlock look like a health nut.

Do these people know that they are making poor choices? Do they have any idea of the health implications?

Some wouldn’t. Some would.

If you did know, why wouldn’t you do something about it?

The answer is disturbingly simple: because it is hard. Anyone who has tried to make major lifestyle changes like giving up smoking, exercising more and eating healthier will attest to this. Changes like these – getting your “2 & 5“, kicking the fags, and giving up drinking, are all hard. Very hard. Too hard for many. I would argue, too hard for most.

I have a lot of respect for those that are able to make these changes. Which brings me to another ICU nurse,The Hungry Addict.

The first entry on his blog is as follows:

Welcome to my Blog. I am a 36 year old fat guy who is about to embark upon a journey to change my diet, lifestyle, and emotional state. I am an addict. This is no joke. My drug of choice is fast food and fried anything. Nothing relieves the stress of a bad day more than a greasy double cheeseburger and some hot salty french fries. And I eat this sort of food everyday, usually two to three times a day. A buddy at work has commited to be my personal trainer and dietician for the next 12 weeks. I am reluctant to abandon my old ways. I have been diagnosed with Metabolic Syndrom X. This syndrome comprises some of the following traits: abdominal (or visceral) fat, low HDL cholesterol levels, high triglycerides, and hypertension. I decided to have a coronary calcium scan. The scan showed calcium deposits in the LAD and circumflex, two large coronary arteries. Faced with this increased risk of early demise, I have signed a contract with this friend to commit to his program. I don’t want to abandon my wife and children to heart disease. I have let down all pride and posted pictures of my fat ass to set a baseline. At the end I shall, hopefully, post pictures of a healthier me. Thanks for following. I hope to become an inspiration to someone out there.

This guy is essentially attempting to do what many should do, but are unwilling or unprepared to do. He is trying to change his eating and exercise habits. He is trying to lose weight and reduce all of those risk factors that combine and conspire to put you in a hospital bed or in an early grave.

Will he succeed? I don’t know. I hope he does.

Will he inspire others?. I hope so. I personally am now been compelled to question whether I really do want that delicious, bubbly can of ice-cold Pepsi, or whether I want the healthier choice of cold water.

Whatever the outcome, you can follow his progress here. Good luck, Hungry!

Emergency trolley… what’s that?

Years ago, after the wetness behind my ears had started to dry, I decided to do a couple of agency shifts to earn a little extra money. Apart from the extra cash, I also gained an appreciation for my normal workmates and for my normal workplace.

My very first agency shift was the shift from hell – a carnival of WTF moments that made wonder if someone was playing some kind of joke on me and if I was being filmed. It was a shift that would end with me refusing to ever work in a particular hospital again; and questioning how it is that private patients really think that they get superior care in private hospitals.

I arrived on the medical specialty ward and set out to find one of the nurses to introduce myself and find out where I could stash my bag.

There were no nurses to be found. This was, in hindsight, to be an ominous sign…

After checking the entire ward, and knocking on a few doors, still no staff. So I went and waited at the nurses’ station. An orderly came along and asked me if I needed anything. I explained to him that I was the angency nurse for the afternoon and that I couldn’t find any of the nursing staff.

As it turned out, neither could he.

This was not good…

So the orderly decided to show me around the ward and point out the pan room, treatment room etc and how the call bell system worked. He showed me were I could leave my bag. Still there no nurses to be seen.

After the tour was over, I asked him where I could find the emergency trolley. He had no idea, and told me that I would have to ask one of the nurses.

I would, of course, have to find one first.

Finally a nurse appeared. I introduced myself. Her response was less than reassuring; showing the same flaccid interest that would be expected from a room full of blokes forced to watch feminine hygiene commercials. I asked her what I needed to do.

“I don’t know…” was her response. The shrug of her shoulders thruly was the icing on her cake of apathy.

“O…K…”, I was trying so hard to be pleasant, “can you tell me where I could find the emergency trolley then?”

“The wha’…?”

Oh my god, she was a dopey one.

“Can you tell me were your emergency trolley is?”

All I got was a blank look. I continued. “Your emergency trolley, dear. Crash cart? Crash trolley? The defib?”

A lightbulb went off in the dim recesses of her head, “Oh… that…”

“Yes. That. Where is it?”

“I dunno.”

The blank look of ineptitude on her face made it perfectly clear that she was, indeed, serious.

I left her and tried to find someone who had some idea of what they were doing. I found someone. Or so I thought. “Hey there. I’m Penguin. I’m your agency RN for this evening. Can you tell me where I could find the emergency trolley?”

She looked me up and down and replied, “You’re gunna haff to speak to Rhonda – she’s in charge.”

“OK… where can I find Rhonda?”

“I dunno.”

I could see a pattern forming… “Well, while we wait for Rhonda to appear, could you tell me where the emergency trolley is?”

“The what?”

“The emergency trolley… the defib?”

“Ohh… naaah…” was the response.

I was certain that this had to be some sort of joke. “Do you normally work here?” I asked. She did. And aparantly it was not of any concern to her that she didn’t know where the emergency equipment was.

At this point the delightful Rhonda appeared. Introductions were made, and before we could discuss allocations, I wanted to know exactly were the Packer Whacker and all the emergency goodies were. I asked where the emergency trolley was kept.

“The what?”

God fuck me dead, it was Groundhog Day. “The emergency trolley, Rhonda. Where do you guys keep your emergency trolley/crash cart/defib? Where, exactly?”

“What do you you want that for?”

As my right eyebrow soared into orbit, I tried to remain as diplomatic as possible. “Rhonda, in the interests of patient safety, I need you to show me exactly where I can find the emergency trolley, should it be required for an emergency this evening.”

“Oh, it’s down the hallway somewhere.”

“Rhonda, I don’t mean to be obtuse, but your use of the word somewhere does not fill me with confidence. Show me exactly where it is kept.”

You’d think that I pissed in her corn flakes by making her amble down the hallway.

“I think it’s in here”, she said as she opened up some sort of utility cupboard.

No darling, that’s not it.

Nor was it behind door number 2.

“You can’t be serious…” Oh, but she was.

Third time lucky…

I stood there wide-eyed, shaking my head. As politely as possible, I let dear Rhonda know that it was totally unacceptable for all three nurses on a ward – especially the Nurse-in-Charge – to have no idea of where the emergency tolley was kept. I couldn’t believe what I had just seen. In the back of my mind was a little voice, saying “eject eject eject”. Part of me thought that I should have just pulled the pin and refused to work in an area that appeared thus far to be hopelessly unsafe. The other part thought that I should stay for the sake of the patients.

I decided to stay. I wish I could say that things got better.

They did not…

2009 Australian Medical Blog Awards – Vote 1 prn penguin!

Voting for the 2009 Australian Medical Blog Awards is now open over at Apple Quack. You can vote for your favourite Australian medical blog here.

I have been privileged to be nominated in the short-list of 5 finalists which are:

Aequanimitas – A doctor’s blog about emergency medicine, toxicology & intensive care
Degranualted – A pharmacist who is also a medical student
Life in the Fast Lane – A Western Australian ED doc with a passion for medical education & informatics
prn penguin (me) – An ICU nurse who believes that you should always have a penguin when needed
Vagus Surgicalis – A Melbourne medical student

So check out the competition, and head over to here to cast your vote.

As I couldn’t vote either of my favourite Australian medical blogs (ImpactED Nurse & The Dragonfly Initiative), and because I thought it poor form to vote for myself, my vote went to Aequanimitas. If the videos about homeopathy don’t tickle your fancy, maybe this will.

Remember that, unlike in the United States, voting is compulsory in Australia. So go and exercise your democratic blog reading rights and vote before the polls close on 20 February 2009.

Found in translation

She was old. She was Colombian. She was scared.

She was my patient.

And she barely spoke a word of English.

According to handover she could say “yes”, “no”, “hello”‘, and “thank you”. And that was about it. “Hello” is always good. “Thank you” is always welcome; and let’s face it, “yes” and “no” are pretty-much useless out of any understandable context. This was going to be a lilttle problematic. I’m a firm believer in the power of mime as a method of communication, but I would really like to understand what my patients are saying.

The only Spanish I knew was from what I had picked up watching American TV, and from a 60 second Spanish lesson that I got many years ago from a South American nursing home AIN. Somehow, I thought that a Speedy Gonzalez “Andelay, andelay! Yee Ha! Yee Ha!” would not be approriate. Nor would an Arnie-esque “Hasta la vista, baby”. The only nurse on the floor that actually knew some Spanish, didn’t want to talk to the patient, because she reckoned that she couldn’t remember much and didn’t want to look stupid. Fortunately, if it’ll help my patient, I’m quite happy to look stupid.

So I went over to her and bumbled through a greeting. “Beunas tardes, Senora”.

Well, the look of fear on her face evaporated. She lit up and started babbling something in Spanish. She was excited. Finally someone was speaking to her in a language that she could understand. To my shame, I had absolutely no idea of what she was saying.

I stopped her. “Perdano, Senora. Me no hablo Espanola.”

She looked a little confused at this. And said something else that I couldn’t understand. Again, I apologised and let her know that I didn’t understand Spanish. “Perdano, Senora. Me no hablo Espanola.”

I told her my name and that I was her nurse. “Me llamo, Penguin. Me enfermero. Me su emfermero.”

She then said something that I woud like to think was the Spanish equivalent of, “but Penguin, you speak so wonderfully, I can’t believe for a second that you are not a native Spanish speaker!”

This was obviously a little confusing for her, so I set about demonstrating my exceedingly limited command of her native tongue, by listing what I could say.

“Buenos días
Buenas tardes
Buenas noches
Sí
No
Uno, dos, tres, quatro, cinco cinco seis (I am pretty fly…)
Me llamo Penguin (I learned that from Family Guy)
Hasta la vista, baby (in my best Arnie impersonaltion)
Uno momenta por favor
¿Cómo estás? (Thank you Scrubs)
Me casa, su casa
Gringo
Muchos gracias, me amigo
Adiós”

During this, I kept pointing at the TV. The penny finally dropped with my impression of Speedy Gonzalez, “Ariba ariba! Andelay, andelay! Yee Ha! Yee Ha!”, complete with improvised sound effects of Speedy running away (turned out it was appropriate). She realised that I coulld only say a couple of phrases, but appeared far more at ease. I did a set of obs, and had to dig a little deeper into my repoitoire, for “where does it hurt?”

“Senora, donde duele?”

She pointed to her head.

“Poco o grande?”

She indicated it was a medium headache. I grabbed her some paracetamol and some codeine and kept bumbling, trying to tell her that I had some medicine for her “Estas medicinos para su….”

She took the meds, and looked visably more comfortable. She took my hand and said, “Gracias, gracias”. Truly, I was the great communicator!

Fast forward to the next day. I was working in a different area, but stopped by to see how she was doing. She had a couple of visitors including one bohemoth of a son. He was a unit. She saw me and excitedly started blurting something out in Spanish to her family. I said “hola”, and her son asked me if I was the nurse who was doing the pisstake Speedy Gonzales impersonation to his mum. I wasn’t sure where this was going… He then asked if I would step outside the room. More of an instruction than a request. Uh oh.

We went out into the hallway were he became less scary. “So Nurse Speedy… I want to thank you for all that you did for my mother yesterday. She can’t understand much English, and I wanted to say that I appreciate your attempts to talk to her in Spanish. You’re the first person that has tried any Spanish with her.”

That was a relief. He went on to say that his mum had told him that my Spanish was less than spectacular, but she could understand what I was trying to say and was really grateful that someone actually tried to communicate with her.

We ended up discharging her home to her family. Happy endings for all.

____________________________________________________________

I guess the moral of the story relates to how one communicates with one’s patients. Fundamentally, the provision of good nursing care is dependant on being able to communicate with your patients. A trained monkey can hand out pills and wipe bums, but it takes a bit more to be a good nurse.

We live in a multi-cultural society, where we come into contact with people from different cultures – not all of whom can speak English. Now for a moment, imagine how scary it would be if you were plonked into an alien environment, such as a hospital, and couldn’t understand what everyone was saying or make yourself understood. If you’ve ever been lost in the back streets of Beijing, you might relate… But back at the ranch…

Granted most communication is non-verbal, but it really doesn’t hurt to know a few words in another language. We can’t be expected to speak and understand every language that our patients speak, but knowing a few words in a foreign language shows respect for your patients and is a great ice-breaker. If your Spanish and Mandarin is as bad as mine, you’ll at least make your patients smile.

Adiós amigos.