Friday, August 18, 2006

The Stim Test

Lest, by some slight of fate, I have actually accrued an interested and critical readership to my ramblings, (*shameless trolling for comments!*), and said readers are nurses, let me remind you, that, in general, I hold nurses in the highest regards. WITH A FEW MORONIC EXCECPTIONS. SO, here we go, I will regale you with yet another tale of blundering idiocy on the hospital floor.
'Twas brillig, and the slithey toves, did gyre and gimble in the wabe. All ... No, no, that's all wrong. That was how I slew the Jabberwocky. Beware of the JubJub bird and Shun the Frumious Bandersnatch was the moral of that tale.
Ahh yes. Wednesday morning, 'twas canvas time on a darkened 3 main. I was pushing my wobbly cart through the corridors, on my way to the next patient. It was a cortisol stim test. For the uninitiated, who have not yet been shaved and forced to prance around San Diego (another story for another time), I shall succinctly explain the cortisol stim test. Basically, the doc wants to know how the patient responds to teh presence of teh hormone cortisol. The lab draws a baseline leve, the nurse injects IV ACTH (adrenocorticotropic hormone), we come back to draw EXACTLY 30 minutes later, and again 1 hour after the baseline was drawn. Not rocket science. The toughest part actually, is to get there on time. Before I drew the baseline, I checked with the nurse that we were in fact doing a stim test and not a simple cort level becasue I didn't have the orders which would have indicated a stim test. She said, 'yes, we are doing a stim test'. I asked "do you have the injection ready for when I'm done (slight cockiness that I would in fact get the patient)". OK. "I'll inject it a half hour from now". NO. I don't htink that's how this usually works, shielding myself from some possible exception. "Let's see what the chart says, she suggested". Flipping through the pages, we found a blurry flowchart from pharmacy, detailing the exact protocol for stimtests which I outlined previously. Turning some more pages to make sure the doctor didn't order some exotic exception, we found the written order "perform ACTH stimulation test, per pharmacy protocol" In other words, do exactly as I have already said. I thought that three explanations were sufficient. "I'm going to draw the patient" I said. Ok, she replied, when you're done, I'll give the injection. GOOD, i thought, now we're getting somewhere. As I left the room, baseline blood in hand, she said, "see you in a half hour", which, to me, meant that she was now going to give the injection and we would proceed as planned. I continued my merry way. Since the lab called me away to another floor in the meantime, I knew someone else was going to finish the stim test. Once I got to the lab, however, word came back that the dolt nurse had waited the half hour she had promised to, even after going through the procedure in excruciating detail. SO, the whole thing had to start again, since the baseline I had drawn was worthless. WHAT THE CRAP DO YOU LEARN IN SCHOOL? I MEAN COME ON!!!!! We read the orders from pharmacy. We read the docs orders. I explained how it works. All of this took place in less than 5 minutes. Yet, within 7 minutes, she had somehow learned A TOTALLY NEW PROTOCOL and ruined what work I had done. AUUUUGHHH. I swear, if I"m ever an elected official, I will see to it that all correspondance schoools that offer "nursing degrees online" are disavowed and de-credentialled.

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