The Heart is a Lonely Hunter

So I should be studying how to interpret 12 lead EKGs, because sadly, when it comes to interpreting them, my speed is far from Dale Dubin's expectation of "rapid" as his book title claims I ought to be.

Instead, I nod politely quelling a semi-horrified look when I notice ST depression on a patient with current chest pain when the house officer/PA says, "That's some pretty significant ST depression. Let's call the attending."

(I'm embarrassed to admit I'm better at reading lead II and v1 telemetry strips: " Ooh! There's a bundle branch block! oooh! 1st degree AV block! Look at that pretty atrial flutter.... my, isn't it textbook? Oh shut up, telemtetry monitors, for the fifteenth time in twenty minutes that's not V-tach, that's simply Mr. Confused Man picking off half of his leads and wriggling out of his posey." Or, my favorite, overhead from one nurse to another, "Oh yeah, well your little ten beat run of V-tach doesn't have anything over my 21 beat run of Vtach. Check it out [presents longish strip of impressive V-tach] My Vtach is better than yours." Of course we weren't talking about our own lethal arrhythmias but rather those sustained by patients as evidenced by some fairly nasty looking telemetry strips. And no, we're not horrid , evil unfeeling people, just somewhat desensitized to the general population's concept of "sick." And yes, we went to check on our patients, or they had the runs overnight and were already in the chart. )

I know nursing school and divinity school and a humanities background in general is supposed to teach you compassion and (snarf) cultural sensitivity and stuff like that, but after awhile that stuff only works on a personal, face-to-patient level, everything else becomes gallows humor.

I once said in divinity school that my want-to-be-a-millionaire scheme would involve marketing a series of action dolls named after certain theologians, like "Tillich: Ultimate Concern included!" or "Kant: Pure Practical Reason Available for Small Surcharge." I don't know why, in particular, I thought this was a clever idea, because in retrospect it sounds pretty geeky and lame (I went to divinity school, okay, quit throwing rotten cabbages/silver bullets my way, please). But I think it was because my Jesus action figure idea was already taken (damn mass marketing) as per below:



Katy: didn't you and I come across a Jesus action figure in Hillsboro division of Nashville once? Remember, in that one store, when we went there over that one summer? You remember, don't you, because it was that one summer that was hot and humid? I swear it was the same action figure, but maybe I'm becoming delusional in my dotage. I've already sustained some short term memory loss, as evidenced by my lack of any detail that would provide you a substantive idea of what the hell I'm talking about...

Any way.

The point of mentioning Tillichian action figures and the fact that Jesus action figures apparentl have found a niche in the pop culture marketing world (glide serenly on wheels! Dashboard Jesus not available at all retail locations, as per packaging) is that I've basically substituted one mania (religious/theological ideation) for another (chronic and acute diseases). So now I'm that nurse that refers to her patients when giving report to other nurses as "CHF Man with COPD exacerbation" or "Hemodylasis Woman" or "Actively Dying, Endstage Cardiomyopathy Full Code Nightmare" or "Obtunded Full Code Man."

And yes, I've actually thought about marketing a line of hospital figures, like "Medical Intern: bright shiny white coat, pager with real beeper number included. Also comes with erroneous order sets for you to find and correct! Clueless/sleep deprived expression free of charge." or "Transport", which would actually feature a box with a stretcher, and DIY instructions, since so many of them can't seem to find their way to our floor on time.

To which I must now end with an "overheard" (honest, it's true):

Situation: Patient obtunded, barely responsive. Needs STAT everything, including an EKG:

JAMIE:
[hurriedly, to newly hired tech]
Hi there, do you know how to do EKGs yet?

TECH:
Yes.

JAMIE:
[fiddling with stupid EKG machine and preparing it to run it down to patient's room by myself judging by the look on tech's face]
Okay, well can I have you do me a favor and run a STAT EKG on the patient in room blah blah blah?

TECH:
[genuinely confused]
I don't understand. What's a STAT EKG?

JAMIE:
[supressing throttle-throat reflex in light of patient in distress]
It means "an EKG YOU HAVE TO DO IMMEDIATELY."
[said while running down hallway with EKG machine towards patient room]

TECH:
[calling down the hall after my fleeting form]
So, you still want me to do EKG?

I love nursing. I LOVE NURSING. YOU HEAR ME? LOVE IT.

P.S. Patient turned out to be fine. Just taking a long, scary-looking, Cheyne-stoking, unresponsive-looking but completely harmless nap, apparently. You have to love dementia.