The Hat

One of the best interventions I witnessed over the years.

A creative physician assessing an actively psychotic, hallucinating and escalating pt brought in by EMS would successfully stop the process by asking "Did you have the hat on"? It always seemed to cause the pt to tune in and say "What hat"? The physician would calmly explain "The tin foil hat. If you make a hat out of tin foil and wear it when they start to communicate, they can't get through to you and your safe". Escalating psychotic patients would stop, look up and say "I didn't know that". No more problem, they had a plan now. They settled down, were admitted to the psych unit without the whole explosion, restraints fiasco. As they left for the floor one of us would always say "Good luck. Next time, remember the hat".

No Room in the Cooler

Cruise nursing had some strange moments. This said by an ER nurse who thrives on adrenalin and strange moments. This was a cruise line that catered to a senior crowd. That meant that a huge percentage of the 1200 passengers were obese, Diabetic and had started smoking non-filtered Camels and Luck Strikes at the age of 14. Now, they were spending 10 days eating 5 desserts a day, drinking heavily and doing the "pursed lips" breathing after dancing. I can't tell you how many would wander down to the infirmary 4 days into the sail and say "I left my medicines (all nine) at home by mistake". The infirmary stocked only a very small selection of medications but would provide prescriptions so the individual could wander off the ship and find a pharmacy at the next port. Pre-existing CHF took it's toll.

On this particular cruise #4 seniors went into full blown CHF and "passed over". The standard procedure was to put them in the cooler down below until the next port, then ship them off to home with their family member. I guess the "cooler" didn't have enough room for all #4. So I was told to "call the flower girl and tell her it was now housing a body and not to freak when she went down in the morning to gather her plants. Can't say I've ever had to make a call like that from the ER.

Glow in the Dark Condoms

I walked into the GYN room to greet my latest patient. She spoke no English but was able to get across the idea that something wasn't right "down there". I pantomimed a Gyn exam and she seemed to understand. The boy with her stood in the corner looking at his shoes. Every now and then the gal would say something to him in Spanish but he never spoke. The Doctor came in, legs put in the stirrups and the next thing I see being removed with ring forceps in a bright green with red, yellow and orange designs glow-in-the-dark condom. Apparently "one size fits all" was not the case here. Because it was not "snug" enough, the condom got left behind. My patient was smiling and happily discharged. Her "guy" never looked up from his shoes.

I left the room and went to my heart patient who had been having runs of tachycardia. Her Doctor was in the hall looking flustered. He turned to me and said "Just once I want a normal patient. She's got cocaine in her urine but keeps denying she has used any drugs. Even when I show her the urine results she says 'It must be a mistake. They must have used someone else's pee'. I just once want a patient who doesn't try to BS me". I looked at him inquisitively and asked "Are you flustered because you didn't think an addict should lie?" He apologized and said he was just frustrated today. I told him "Well you could always tag along with Dr ____. He just pulled a glow-in-the-dark condom out of a gal". He burst out laughing and said "Thanks. I needed that. You always seem to give perspective." I'll take that as a compliment.