This is how I remember the first weeks after the arrival of a new
group of hospital house officers. Things may have changed and only retired nurses and hospital personnel may remember. This month*s corner is for them. My other two readers may wonder what I*m braying about, but there are other columns and serious MPN oriented articles for them in
this issue. I*m not bashing new doctors. I used to be one myself and probably more callow than most.
Summer*s over and change is in the air. Outside the
hospitals the leaves are turning and the days and nights are comfortably
cool and work goes easier. Inside hospitals, things are again going
smoothly at nurses* stations, pharmacies, records typing pools, clinical
parking garages and telephone switchboards.They have once again survived
another bout of the dreaded Hospital Summer Virus (HSV).
The trouble begins annually in July and only begins to
wane around Labor Day or beyond. Now things have once again returned to
blessed normalcy. God is in his heavens, Congress is in recess and the creek we were up without a paddle has receded. In other words the hospitals are
functioning smoothly and among the personnel there is much less
muttering, sighing and taking of excessive sick days. Hallelujah!
Back in early July the annual onslaught of June*sgraduated,
licensed, certified or whatever mark of distinction was appended to the
new and unimproved members of the afore-mentioned departments began.They quickly wreaked their destructive side effects on the wards, not to mention the patients. That*s HSV.
>>clinical pearl>> Experienced patients try never to be voluntarily
admitted to a hospital in July.)
Studies show that the most infectious carriers of HSV are the newlyminted house officers, conscious of their shiny new (read dangerous) MD*s or DO*s with the ink still wet on their sacred diplomae (or is it diplomas). The regal chief Residents and Fellows transferring from institutions they claim are more famous, who always have a better way of doing things also carry the HSV virus.
What are the symptoms and signs of HSV? They can be severe, but
fortunately the disease is self limited (that is if we stay out of Mother Nature*s way in her efforts to heal). Every hospital suffers differently, but always the suffering and the burden to teach the fledgling house staff and ameliorate the symptoms of HSV falls mostly on the nurses.
Symptoms and Signs of HSV:
1. Three pages of orders for nurses to copy. Often another page is added later on the same day.
2. Twenty PRNs ordered for each patient*s every contingency from a hiccup to dandruff. As if the nurses had never heard of a glass of water, a back rub, bathroom privileges or an enema.
3. Newly important doctors make ward rounds getting in everybody*s way
at seven, three and eleven. always just in time to interrupt nurses* narcotic and drug tally, nurses* report, patients* baths and the arrival of food carts. (old hands and house officers with nurse spouses know better than to show up at these forbidden hours).
4. The young single male doctors soon learn to box
sheets, serve trays,collect urine and draw blood for a female nurse, aide, dietitian or lab.tech. whom they fancy and want to assure they will get off-duty on time.
The reversed gender approach happens less often or at least is not
so obvious. Anyway nowadays, so I*m told by my wife, doctors marry doctors,
nurses marry nurses and so on, sparing a few head & heart aches. Abnormal hormones may circulate in some patients* plasma, but certain strong ones run rampant in young warm blooded house officers. Marriage licenses, divorce papers, positive pregnancy tests affirm these clinical trials. Most times happiness results, but sometimes there are broken hearts.
5. Two thousand word progress notes are dictated daily, some days twice,for the records department to type and type …and type some more pages that nobody reads. Good job protection for the typists and the electronic records industry, but such a pain for everybody else.
6, A bewildering soup of jargon, puzzling acronyms and unintelligible abbreviations from other hospitals and institutions suddenly appears in the medical records. ex; how many acronyms are there for a big benign prostate? BOP?, BPH?, ???.
7. A mixed bag of weights and measures, chemical and brand names all written in Latin or Greek or something vaguely suggestive of Sanskrit appears on order sheets or verbally ordered or dictated in the unintelligible variations of English that emanate from well known universities.
8. Scissors, stethoscopes, pens, cell phones, small change, phone books, etc. are *borrowed* from nurses and never returned without gentle persuasion.
9. Drugs and formulations are ordered that no self respecting pharmacist has ever dispensed or heard of since her/his pharmacy school days.
10. DNA & serum copper tests are ordered for an emergency
appendectomy for an otherwise healthy patient, stat at 3 a.m. on the weekend.
11. Stale doughnuts are offered in failed attempts to
bribe long suffering records librarians in lieu of getting medical records up to
date and on time.
12. Chief of staff*s parking space is taken up by a VW camper. Patients*
wheel chair entrance is blocked by a motorcycle with a guitar, a half consumed donut and a Red Sox cap, plus a pilfered box of bandaids, six new hospital towels, a dozen hospital diapers and a package of peri-pads, all resting on the seat.
14. Telephone operators are awakened at 3 a.m. by a
house officer*s tearful or angry spouse with much sobbing or growling. “Please
let me talk to Doctor Jane/Jim Jones. She/He said She/He would be home soon and it has been over three hours. Oh, the worry and grief …and suspicion.
Other iatrogenic hospital viral syndromes occur in July. The differential diagnosis is long and each hospital is different, but the SHV syndrome is so widespread that I*m sure all our Nurses, Pharmacists, Records Staff, Parking Attendants and Telephone Operators will recognize it instantly.
Anyway, as I wrote many parentheses, comma faults and *run-on sentences* above, it*s Fall and the SHV syndrome has abated. By
this time the nurses have taught well and the trained and indoctrinated
house staff understands the real pecking order and power structure.
Happily, the hospital wards are running smoothly once again. So this is enough blather (too much?) until next month when I might discuss some of the other non-clinical goings on around hospital wards that took place back in the
day, Interesting things happened that patients and administration never knew about. Reckon I better not. Some of my peers are still alive and they might subscribe to MPNforum. 🙂 Best,