Blue Mole Surgery

Apprehensively, I showed up at the outpatient surgery clinic to have a blue nevus removed from the tip of my nose. For the past 2 years, people have been trying to either rub the “spot of ink” off my nose, or to tell me to rub it off. For 2 years, I have had to say, “It is a beauty mark.” It looked suspicious from the start. I thought it was a blackhead at first, and tried to squeeze it until the wound healed and it was still there. Then I pulled out my nursing books and googled “malanoma.” That is what it looked like. I tried to ignore it.

 But then my coworkers and family started trying to rub it off. Coworkers scared me enough to run to a dermatologist. He biopsied it. Now that was painful. The tip of your nose is one of the most innervated areas of the body. Stick a giant needle full of lidocaine into it, and, well, I had to force the back of my head into the pillow to not move. Not to mention, the lidocaine didn’t work much. Then the medical assistant taped a giant white Rudolph dressing to my nose and sniggered my whole way out the door with the desk clerks. It came back a blue nevus, which in layman’s terms is a blue mole.

Blue moles are benign. But mine was growing, so it was an abnormal blue mole. It had to come off, lest it become cancer. Then I got pregnant. It could not be removed while I was pregnant. And pregnancy hormones make moles grow more. I went back to the dermatologist after the baby was born. He said that because it was on my nose, he wouldn’t touch it. He said to go to a plastic surgeon of my choice.

 So I began asking around about plastic surgeons. Nearly every female coworker who knew of plastic surgeons referred me to the same one. So I went to her. But I was nursing a baby, and she wanted to wait until I was finished. This complicated things. I belong to a few breastfeeding forums, and people were having surgeries and asking for Hale’s look-ups. Turns out this Dr. Hale wrote a book on safety of medications while breastfeeding. But most surgeons don’t want to deal with the issue, so they just tell you to wean the baby. Well, I didn’t wean the baby.  I waited a few months and played it low key.

This story is a lot more complicated and longer than I’m making it.

 Since the biopsy was so painful, I elected to be put under general anesthesia for the removal of the “mole,” which now has spread to two seperate spots that cover together nearly the size of a dime. Local anesthesia was an option, but, as a nurse, I was chicken.

Since I elected to have general anesthesia, I had to have a blood count and an EKG. Now, I work on a cardiac special care floor, and when the EKG lady who knows me, turned my EKG over instead of showing it to me, I said, “Let me see that.” Sheepishly, trying to cover the print on the top, she handed it to me. It said, “septal infarct of unknown age.” Septal infarct = heart attack. All the way home I was trying to recall any point in the previous 10 years I might have had a heart attack. There was the time my ex tried to take the kids from me by filing emergency motions in court saying I was a danger to them. There was the last trimester of this pregnancy when my ribs hurt like the dickens. Was that my heart? Then I googled septal infarct, and found that a septal infarct was the most common misread of EKG machines. When I approached my boss the next day about the impending cardiac work-up the plastic surgeon was going to demand (and she did, consequently), he confirmed what I had read about misreads, and also stated that this had happened to another nurse of his. She was given the reasoning that “mammary tissue sometimes skews the EKG waves.” Made sense. I’m nursing a baby.

He got me to pull aside one of the cardiology nurse practitioners, and subsequently a cardiologist, who scheduled a sooner-than-it-would-have-been echo in his office. The pretense was that our floor was short-staffed, and the boss couldn’t afford for me to take time off for a stress test and all that jazz… and the echo showed that I did not have a heart attack, thankfully.

So today, finally, nervously, I went in to have this little spot removed from the tip of my nose. If you’re sniggering, or stunned, you are not the first. That’s the way it goes, people. I got in my gown; put on my paper slippers and paper hat, and got helped onto a stretcher. It was parked in the pre-op room. The nurse put a #20 IV into a little vein under my pinky.  Ouch. I mean, my pinky actually went numb, it hurt so bad.

Then for 2 hours, I lay in front of a TV tuned to my most despised channel, Fox News, which blared over and over and over, Paris Hilton’s release from prison. I tried to sleep through it. All the other patients went to the OR except for me. At some point, when I felt I was going to lose my cool, I asked if my husband could come back, and thankfully, they went and got him. He was much more pleasant to look at than Paris. I told him so.

Finally, a nurse anesthetist came and pushed something into my IV. I asked, “Is that Fentanyl?” …”yes.”  “And Versed?” …”yes.” My husband smiled a silly smile, and waved at me, “Bye, bye.” I laughed. They wheeled me to the OR, and before I got there, I told them the ceiling was spinning. They found that amusing.

I remember being asked if I felt okay, and responding that I did. Then I remember hearing the words, “We’re done!” And, “Do you have a specimen cup?” I asked, “Are you doing a biopsy?” Trying to open my eyes I saw I was in the OR, and realized the surgery was over, even though it still felt like I’d just gotten there. Then someone said, “That was a really big melanoma!” For a second I felt a wave of panic, and then I remembered them questioning the woman going in before me about her lesion, and realized they were still talking about her, the surgery before me. They wheeled me out of the OR to a recovery cubbyhole.

There was a clock on the wall. It said 12:00. I had gone in at 11:15, so it was 45 minutes later. I might have been loopy, but I still had my lucidness. I had a new nurse – the recovery room nurse. I asked if there was a mirror around. I wanted to make sure the big melanoma wasn’t from my nose. I closed one eye at a time and looked at my nose. It was still there. I could barely see the dressing. It wasn’t like the giant thing the sniggering dermatologist’s medical assistant had taped to my nose. The nurse told me there were steri strips there, and probably stitches underneath them. She said the mirror was in the bathroom, and I would be allowed to get up and look when I woke up a little more.

That’s when I realized how good I felt. I just wanted to sleep and enjoy feeling good. So I did. The monitor alarm kept waking me up though. When I craned my head around to look at it, my respirations were 7, or 10. I was a little too sedated. I had told them before going in that narcotics snowed me. I guess they found out. The nurse kept checking me frequently, and I chuckled. Only once in my career did I let a patient’s respirs get down to under 10. Served them right. I went back to sleep.

Bruce and I ate at Eatin Park. I got a King Cod sandwich with fries even though they told me to eat light at first. And coffee. And water with lemon. I ended up giving Bruce half the fries, and only ate one piece of fish out of the sandwich, and took the rest home. The afternoon was quiet – he went to the farm to do some work. I watched a movie I’d rented on Alfred Kinsey, while holding ice on my nose on 2o minutes, off 20 minutes, 4 times. I took ibuprofen and Keflex. I didn’t take any Tylenol #3 because Hales said that some women have a gene that makes it into thrice the morphine in their milk, and babies have died from mothers taking it.

I have to say that at 10pm and 4 ibuprofens later, that my nose is about a “2″ on a 1-10 pain scale.

 The worst part of the surgery? Paris Hilton for 2 hours. The rest wasn’t too bad. I think Dr. Pare is a great plastic surgeon. Maybe I’ll still think so when the steri strips come off in a week.

It All Started

It all started when I had had enough, already. This phase I mean. This phase is after the disillusionment and the vision. This is the genesis. The disillusionment began long ago when I experienced a child and a parent being hospitalized within months of each other, and as a result decided to become a nurse myself. The trek to becoming a nurse is a story in itself. And the vision began after reading the first few chapters of Walter Wink’s book, “The Powers that Be,” when it dawned upon me that the healthcare system could be applied to his model of sick institutions, even though he spoke of religion. But the genesis of this blog began on June 1, 2007 when my father had a right frontal stroke. In August, I will have been a nurse for 10 years, and this trip that seems far from reality – but WAIT – it IS reality – this trip through his stroke made it all come together.

Hilary Clinton has been saying there is something seriously WRONG with the healthcare system. People have been saying that for years. The images of doctors in labcoats marching on Charleston’s capitol lawn are burned into my brain. I was working in home care then, and most of the doctors in the West Virginia panhandle (in our home care area) were out of town that weekend – and on strike. Several of my home care patients kept the channel on court TV the whole duration of my visits around then. Many mentioned their doctors’ sportscars or other perceived gluttenous extravagances, as if they were Tammy Bakers. My sister in the fashion district in NYC was writing me, “I work hard, so I play hard,” and the doctors had the same attitude.

 Another image burned in my brain is the daily dressing of a rotting black foot of a patient, sitting in front of his TV sipping on a sugary soda, and a big cake his wife had baked him sitting on the kitchen table in their pristine clean house; court TV blaring; him barely speaking to me during the dressing. That was the year I started looking for another career. That was the year I really liked coming home to my goats and taking the dog for a walk on the farm. That was the year I decided I’d rather be a farmer than a nurse.

But Walter Wink has been whispering to me ever since. It is June 21st. My father has been in 5 acute care institutions since June 1st. His blood sugars were never managed sufficiently. The dieticians in not one of the institutions catered to his and my mothers PERSISTANT requests for NO REFINED FOODS. He was supposed to go to acute rehab, but that facility sent him back to the hospital after day 1 for out of control blood sugars, and after he returned, the very next day for a temperature (imagine….after high blood sugars for 2 weeks, that he would develop a temperature). The second time, the nurse on staff sent him to the wrong hospital. I guess it was too much of an emergency for her to take a look at his chart. It turned out to be a blessing in disguise though, because the hospital staff and doctors were a little more pliable.

We insisted this time that he come HOME. The social worker at Wheeling Hospital tried to tell my mom that the insurance wouldn’t pay for his hospital stay. Old story. I’ve been told to tell patients that, and it is a lie. I made a beeline to the nurse’s station, found a nurse, and informed her that this was not true – that the insurance WOULD pay if the doctor wrote the discharge orders. She admitted that was true. I told her the doctor needed to write discharge orders. I backed myself up with the course of events of the previous 3 weeks and my father’s condition as a result.

So here I am. This is not even the tip of the iceberg; it is only a figment of the consciousness of the problems I perceive. We all perceive them. There are solutions. We have to call the healthcare system back to its mission. We have to seek Truth. The creation of this blog is not easy for me. I don’t know where it will go. But I feel called to do it. So here I am.

Chat With a Resident

She was up to the floor to check someone in rapid A-fib, and was finishing up her physician’s notes, talking about …what was it? Vacationing in the Caribbean. Two nurses had just returned with tans to die for. So I posed the question.

 ”How are admitting privileges established with any given hospital?” The question seemed to suprise her. She tried to answer what she thought I was asking, but I had to keep asking questions to steer in the direction I was seeking. “When physicians are licensed in the state, how come they can only practice at certain hospitals?” Her answers were all over the place. Finally I told her about my father’s experience with his stroke. And I said that I thought admitting privileges might cause more medical errors and prolonged stays than about any other issue in hospitalization. SHE AGREED WITH ME.

Among the issues discussed:

- Doctors don’t want to be pulled every which way and like to limit their practice to one geographical area.

-Hospitals use admitting privileges as a way to staff certain needs. For example, to gain admitting privileges to one hospital, you might need to have done X number of cardioversions, and have to give that hospital documentation that you’ve done so, along with other skills. This way they know when you’re overseeing residents, you can run a code properly. To have admitting privileges, you have to serve X amount of time overseeing residents. If you are a cardiologist, you may have to read EKG’s at set intervals. So for a doctor, establishing admitting priviledges at more than one hospital may require extensive paperwork and time commitments.

 Okay, I can see the purpose in the hospital functioning, and to a degree in patient care. But if the way something is set up causes more errors and more expense in any given illness than other issues, shouldn’t its efficacy be questioned and looked at? I think so.

Genesis

Did you ever think back about the way things once were, and wonder why it was ever that way? How did people exist without computers, for example? Whenever the computers go down at work, the nurses have to chart medications – on PAPER – and they act like it is prehistory.

 Doctors have admitting rights to only some hospitals and not others. Why? I intend to find out. They have to maintain a license in the state, so what is the difficulty? I believe this one limitation of the medical system causes more errors and harm than many other issues combined.

My father has spent the last 2 weeks having a stroke, being worked up for it and in the process has been in 5 medical facilities. I will have been a registered nurse for 10 years in August, and as far as we’ve come in medicine, I believe we have a lot further to go.

I intend to write about some of the problems I see with the medical system here, and to discuss why they are problems, and what might be done about them. I hope to affect some rational change in the beaurocracy of medical care by discussion of how the institution of medical care veers from its mission.