Armchair Anonymous: Nurses III

Welcome, welcome, welcome to Armchair Anonymous. I'm Dan Shepard. I'm joined by Lily Padman. Hi. This prompt delivers. It delivers on the level that Foreign Objects does and does unauthorized evacuation. It's a good prompt. It's Nurse. It's Nurse 3, and I'm here to tell you there's going to be Nurse 4 through 100. That is my commitment. We got it all. What these heroes are going through. This would be our one story of our whole life, and these people have to figure out which of 150 stories do they want to tell us. I bet we'll have some folks back. I hope, yeah. Okay, please enjoy and be in a place where you can run to the bathroom. Nurses Part 3. We get support from Quince. I have to say I am so ready for fall. I want sweaters. I've been craving a true crisp morning where I actually need a jacket. I can't wait. I'm fully there. The second it dips below 70, I'm like, this is my season. Give me the layers. Give me the boots. Give me a reason to wear something other than a t-shirt. And honestly, that's why I love Quince. Because fall is when your wardrobe actually has to show up. And everything at Quince is 50 to 80% less than similar brands. We're talking 100% Mongolian cashmere sweaters starting at $60. $60. $60 for cashmere that you'd expect from a luxury brand without the luxury price tag. It's amazing. Gets me every time. It really shouldn't be real, but it is because they go straight to the factories. They skip the middlemen and they just hand you the savings. The stuff isn't trendy. It's the kind of pieces you grab over and over because they work every time. The 100% Mongolian cashmere sweaters for me are it. When I look at Steve McQueen, this man owned a couple of sweaters he wore all the time. And he looks iconic. It's a uniform. And Quince isn't just about the clothes. They have hotel quality bedding, cookware, bath essentials, thoughtfully designed furniture. You can really go there and outfit your entire apartment or house. So if you're in need of any kind of fall refresh at home, too, same quality, same attention to detail for every corner of your life. Find your next fall favorites at Quince. Download the Quince app for app-exclusive offers or go to quince.com. Get free shipping on your order and 365-day returns. Now available in Canada and the UK, too. And when Quince asks where you heard about them, let them know it was Armchair Expert. It's the best way to support the show. This episode is sponsored by BetterHelp. If you've thought about trying therapy with our long-term partner, BetterHelp, insurance options may now be available nationwide with an average copay for eligible members of just $23 per session. October 10th is World Mental Health Day, but you don't need a day on the calendar to give yourself permission to talk to someone. I've been in therapy for a long time, and the stuff rattling around in my head always just quiets down the second I say it out loud. And it doesn't have to be some big life crisis. Maybe it's a work-life balance issue. Maybe it's a work thing that's taking up too much space or hard relationship moment or just a feeling that something's off. That's enough. That's worth talking about. You know, I love therapy more than anything. Gets me through. Often I'll want to cancel because I'm like, I don't really have anything to talk about. And then I'll go and I have some major revelation. You know, I was just talking to a friend who has just started it. And I said, one of the most powerful elements of it is just hearing yourself say out loud the thing that's been ruminating in your head and how different it sounds once it's done. You gain perspective immediately just by hearing yourself say it. Yeah, you do. If you've been waiting to start therapy, BetterHelp works with more than 125 health plan networks and eligible members have an average copay of just $23 per session with insurance. Don't have insurance or live outside the U.S.? You can still get 10% off your first month. Do yourself a favor and just try it. Future you will be grateful. Visit betterhelp.com slash tax to explore your payment options. That's BetterHelp.com slash tax to explore your payment options. And Andy, where are you other than in your closet? I am on Vancouver Island. Oh my goodness. Is it heaven right now? It's gorgeous. And we have a pontoon boat. We keep it in the water until like October, usually Thanksgiving, which is middle of October for us. And we use it to the max. And it's in saltwater or in a lake? In a beautiful, beautiful lake. Oh, it's crystal clear. It's green blue. Like it's almost Caribbean colored. Like when you see the people wake surfing, the wave is great. It's gorgeous. The pictures I take of my friends wake surfing, I'm always like, look at the color of the water. You're missing the color of the water. Yeah. I wish I could say the same for our lake, Old Hickory in Nashville. It's quite murky, but we love it just the same. A little brown. Yeah, it's a little brown, sure. But that water you're describing is very much like northern Michigan has Torch Lake, a few lakes that look like the Caribbean or the Caribbean. Yeah, we're so thankful we get to live by. And then we're only a little ways from the west coast, like Tofino, Euclid, which, of course, is spectacular. OK, and are you a nurse? I am. OK, wonderful. How long have you been a nurse? I've been a nurse for about 20 years. 20 years. What's the lifespan of a nurse? And I don't mean like before you die. I mean, like, do people fatigue out of the job? Is it stressful or do people stick around a long time? The beauty of nursing is that you can change your focus. There's so many different areas of nursing. So people kind of maybe burn out in critical care. There's a lot of things that you can do in a critical care situation like emergency and then they'll go to like community, which is a little more chill. I'm an operating room nurse and I love it. I can't imagine doing anything else. After listening to Dr. Death, we need you. We need your eyes on the scene. We're necessary. OK, so you have a crazy nurse story. I do. Our ORs run on a slate, a normal schedule. And sometimes we get emergencies. And the surgeons will come in in the middle of the day. And say, I need to bump in. OK, what does that mean? Bump in. It means that they're going to interrupt the slate as it's supposed to be. People with scheduled surgeries and they need to do their emergency now. Lots of emergencies. We can wait till the end of the day. We finish this booked patients and then add these guys on. But this one, they're like, we need to do it now. They say it's a younger gentleman and he's got an open wound on his scrotal coccyx kind of area. What's coccyx? Your tailbone. OK. So somehow. There's a tear between his tailbone and his testicles. Yes, exactly. And in the summer, we see lots of these because this is a gross human anatomy thing. But when people sit for a long time, often on long, sweaty car rides in summer vacation, they can get an infection or something down there. And so we see a lot of gentlemen come in when they need their scrotum or coccyx area kind of tended to. OK. And is it generally staff? Is that what people get there? Sometimes. Sometimes. It can also be necrotizing fasciitis. That means necrotic flesh like it's done. Yeah. OK. And that's got a really nice smell, right? It's a distinctive one. Yeah. There's no mistaking it. We don't even need to pull back the blankets. We're like, ah, neck fash. Welcome. OK. OK. So the urologist warns us and says, we've seen some maggots. And we're like, OK, no biggie. But this is odd for this location. Like, sometimes we see maggots, but it's on wounds that are more kind of exposed to the air, like limbs. Like legs, or feet, or something. And people who aren't necessarily taking that well care of themselves. Between the patient coming from eMERGE to our operating room, we learn that it's sadly a paraplegic. And the mom was the primary caregiver. And she had passed away recently. And nobody stepped in to care for this patient. And they were kind of trying to make a go of it on their own at home. It's really, really sad. No nurse visiting ever. Just completely solo paraplegic. Yeah. So the patient's not doing well because this infection is now gone systemic. They're septic. We need to get them in and clear out this infection. So we bring the patient into the operating room. We haven't really seen much. We pull back the blankets to move them from the stretcher to the operating room table. And I can see the maggots. They're crawling around. And if you had to ballpark, how many maggots are we talking, 10 or 100? At this point, I can probably see 40 to 60, and they're just kind of crawling. But I haven't seen the wound yet. So we move them over, and we move the blankets. We get the patient to sleep. And then we lift up the legs to check the extent. And there are probably three to four holes that are between, I would say, 5 to 10 centimeters. And they are packed with maggots. Oh, my God. This has got to be like baseball-size of maggots. They're actually tiny, but they're so packed in that it looks like a honeycomb, if you can picture that. It's just maggot butts stacked on top of each other. Yeah. If I'm you guys, like, do I start with raid? No. Normally, so if we have a cavity that we have to prep, like you do surgery, right, you try to decontaminate the area that you're going to operate on. Normally for a cavity, we would take a sponge with iodine solution on it and just kind of swish it around in there. look at the surgeon. And I'm like, I can't. I'm like, all I'm going to do is stir up these maggots. Yeah, yeah, yeah. I mean, are you to scoop them out first? We're trying not to disturb the wound. Like they want to get in there in a sterile as possible way first, right? So he's like, I don't know, just pour it on. So we just start trying to angle this betadine solution into these holes the best we can to like flush them out totally or just to get the area as germ free as we can. We do that and the maggots kind of start to make a run for it. Their instinct is to go into the wound and stay with the flesh that's dying. They all start to come out, but we've got to get on with surgery. So we throw the drapes on, put them on, which is like, you know, when you see surgery on TV, it's all the blue kind of paper and stuff. But they're starting to run. up the patient's body. So we have a scrub nurse that's with the surgeon. And so the surgery gets started. And the scrub nurse and the surgeon are just like scooping out handfuls of maggots and putting them in buckets. And then we're also suctioning them up as well into big suction canisters. But I'm under the drapes because I'm in charge of scooping up all the ones that are making a run for it. And we've got an anesthesiologist, of course, at the head of the bed. And anesthesiologists do what they do because they don't love it. I love the muck and the mire of the operating room. For the anesthesiologist, the thought of maggots heading his way, he was just like panicked. So I'm just under there scooping them into a container and then dumping it and then scooping them and dumping it. We're talking hundreds and hundreds. Thousands. When you had gathered them all, were you putting them in like a five gallon bucket or smaller? For the OR, people who were sterile, they had like stainless steel buckets. They were scooping them in and then dumping. I was just putting them into something else. I was just putting them into like smaller containers that I had under the drapes. When you had the majority of them in the central container, how much volume are we looking at? Probably a couple liters. If anyone can picture the two liter bottle of Coke on the shelf at the grocery store, I mean, fuck. Yeah, it was a lot. And at one point I came up from the drapes to dump and our wonderful scrub nurse, who was actually a travel nurse, was like, I'm going to dump this. I'm going to dump this. It was his last day. And he just looked at me straight in the eye and he said, I do not get paid enough for this. So what did the, then the surgeon goes in and their jobs to try to cut out all the necrotic flesh. So there's no more of that. Yeah. So they're trying to get rid of all the decaying flesh because now that's going systemic and it's making the patient sick. Oh my gosh. And what's the recovery time for this person? They went away to the ICU. I'm not sure. That's the problem with the OR. We, we stitch them up and we send them off and we don't necessarily know what happens after that. When you were younger, did you ever check? Were you curious? And over time you just don't check? We're actually not allowed. They monitor nurses very closely in terms of looking at charts. So if you open up a patient's chart, it's flagged that you've opened it and you can't check on them kind of after you've seen them. And that prevents stuff like looking at people, you know, or looking. So we're really restricted. The only information we get about how a patient's done is if the surgeon knows and they can come back and tell us they did fine or they didn't do fine. Oh boy. What a heartbreaking scenario. Oh, it's terrible. So he must've just felt so bad from being septic. He finally called 911. I think someone went to finally check on him. And what we heard was that he was already down in the home and someone called 911. Oof. If we give that to him. That one at 10 over this 20 years, you've had, I'm sure, numerous 10s. Was it hard for you to pick what story you would tell? Yeah. I mean, the OR, we see all kinds of crazy stuff. Years ago, I had a rodeo guy who got kicked in the jaw by a horse. And normally we would have a certain entry point to fix a jaw, but the horse had kicked him enough that it opened up. So we were able to just go in through the opening that the horse had nicely made for us. Oh my goodness. It's crazy stuff sometimes. Cindy, my deepest gratitude that you're doing what you do. I think everyone feels that way. I mean, it takes a certain breed to be able to look at the honeycomb with the maggots coming out. I looked online to see if I, because of course we can't take pictures and video and stuff in the operating room just for privacy. And I thought I'd look online to see if I could find anything. Comparable. I stopped going down that route. It's like, nope, nope, I'm backing out. You don't want your algorithms to start feeding you that. Yeah. Can I give a little shout out? I would love to hear a shout out. So I'd like to shout out to my best friend, Christy. She is the ultimate arm cherry. You are hands down her celebrity crush and she talks about it all the time. Oh, I love it. Upstairs at Elle's was definitely our track of the summer. Oh, good. And so thank you for putting us onto that. And did you dance with Reckless Abandon? Absolutely. Oh, wonderful. Well, big shout out to her and thanks. I don't know if she turned you onto it or not, but we appreciate it. Yeah, I've been listening for a year. But this was when the nurse prompt came up. She's like, this is you. This is you. You're up. You're up. Go. Yeah. Hit them with the maggot story. For sure. Well, it's lovely meeting you. I hope you get extra, extra days out on the pontoon before it gets cold. Yes. Well, if you ever want to come to West Coast. Oh, I do. We have, I'd say, a disproportionate amount of people we interview from Vancouver Island. I don't know. Shit goes down up there, but definitely on Armchair Anonymous. I'll just say Canadians in general, considering that you're less than one tenth of our population, you're definitely more than one tenth of our crazy calls. Love it. All right. Well, take care. It's so nice meeting you, Andy. You too. Thank you so much. All right. Bye-bye. Hello. Hello. Wow. You have gorgeous teeth. Oh, thank you. Really nice smile. Yeah, they really hit you right between the eyes, don't they? Good. That's how they should be. What fake name should we use? What would you like? I want to say Kelly because you look like my cousin Kelly. All right. If you have no sworn enemies named Kelly. No, totally fine. And where are you, Kelly? Other than a dark room. I'm in the Midwest, and I wouldn't be surprised if at the end of this, you might be able to guess what state I'm from just based on how I talk. Okay, so are you a nurse? I am a nurse. Okay, we love you already. I've been a nurse since 2010, so 16 years. And what type of nurse are you? And I bet maybe that's changed over the 16 years. Yeah, it's been different. I have been a cardiac. I am a cardiac telemetry nurse. I now teach full-time at a technical college, so I get to teach the nurses to be nurses. Is the cardiac telemetry, were you assisting putting in pacemakers? What did that mean? We would care for patients after they had a pacemaker placed. The system that I worked in, we sent patients to a different hospital that cared for them, higher level and stuff like that. So we saw a lot of chest pain patients who were there for a stress test. But then also, of course, everything else. You being a nurse and a teacher crosses over on two favorites. Yeah, I'd say you got two of the four quadrants. I'm not even sure that there's two more, but it just feels like to be safe. Okay, 50%. Yeah. Okay, so you have a crazy nursing story. I do. So this takes place, I think, about 10, 11 years ago. I know I was definitely not a new nurse when this happened. This took place kind of in a Midwest sort of suburban hospital. We admitted this patient. We admitted this patient for severe abdominal pain and hematematous. Do you know that word? No, what's hematematous? I know blood is hema. Yeah, bloody vomit. No. Yeah, kind of my least favorite thing, too. So they were vomiting up a lot of blood. Is there a high percentage guess of what that normally is? Perforation. Yeah, usually we think something's up in the stomach or the upper intestines. We needed to rule out upper gastrointestinal. We needed to rule out upper gastrointestinal bleed and figure out what was going on. Of course, managing the pain was part of this whole care plan as well. And so we immediately had to do diagnostic tests. So EGD, colonoscopy. The EGD found nothing. Not a single source of bleeding. Not even any tissue that was questionable. The gastrointestinal providers was like, I literally found nothing. Not in the esophagus, not the stomach, not the small intestine where they could readjust. Not in the esophagus, not the small intestine where they could readjust. Same with the colonoscopy. Nothing in there, which wouldn't really make sense for vomiting up blood. So you did nose to tail on this person and we don't see any tears or anything. You need Dr. House at this point. Yeah. Yeah, we do. We did blood work, of course. Nothing really showed up. No infection. Maybe a little bit anemic. You know, they're losing blood. So that's what we know for now. In terms of like pain management, that's kind of where I come in making sure that they're getting the appropriate medications to manage their pain. They were getting opioid pain medication through their IV access. I was giving hydromorphone dilaudid through their IV. That's a nice product, you know. Yes. And it was not really doing the trick. I was seeing him vomit up blood, like filling the- kidney basin that we put at the bedside huge clots in his vomit seeing this and vomit is like one of my least favorite things that and sputum so it's like take your pick so that's probably one of the reasons why this story stands out to me so much can i ask how big are these clots are they the size of a penny like a golf ball a poached egg oh yeah poached egg no don't say that don't ruin poached eggs at some point during the hospital stay this is kind of over the course of a number of days that i'm caring for this patient you know the providers are getting a little suspicious about something's up here and so we needed to assign the patient to be a one-on-one sitter you know where we have typically a cna sit with them in their room 24 7 eyes on them the whole time safety reasons right and we needed to make sure that they weren't causing any harm to themselves so i remember being a little bit like oblivious to like these suspicions and thinking i just so badly wanted to believe this patient that something's really wrong what's happening and giving them the benefit of the doubt do you have a guess well sounds moonshells in here right i have a guess but i'm not gonna say okay good guesses okay one of the other things that we were dealing with was that we were not able to maintain like peripheral ivy access so in forearms and hands we weren't able to keep any ivs in there so we did attempt and i partnered with the hospital provider at the time to put in a central line just because we did need ivy access and where's the central line go the central line goes in the neck so they find a neck either just above the clavicle or below the clavicle we attempted to do that at the bedside but that did not work we were unsuccessful we were not able to access this vein that we needed i'm getting junkie clues as well like if you've collapsed a lot of veins they do run out of veins to use yep and so we ultimately were able to place a pick line a peripherally inserted central catheter which dax you know goes in the upper arm has a very long tube that enters all the way to the top of the heart crazy long i would say yes yeah i think when they get taken out everybody goes oh my gosh i know the guy was pulling it for a while i think he had to wind it like a hose as it was coming out yeah so we got the pick line in we were able to use that to administer the iv pain medications and still being watched one-on-one with a sitter and then some of the behaviors we started to get a little bit worried about so i was getting reported to from the sitter about hey this patient keeps putting their head underneath the blanket and so i can't see their face i can't see their head i've asked them to please keep your head visible i need to be able to see you all that stuff and they would just i think pretend that they were sleeping and that it was really bright in there and thankfully because i was pretty good at building a relationship with patients at this time i had to be really stern hey this isn't gonna work like you're gonna have to stay out where we can see you at all times it would work for a little while and then back under the blankets again can we get an age range of this person i was wondering if you would ask i think probably 40s okay okay maybe early 50s so unfortunately we got to the point where there was really nothing else we could do we had no more tests everything was inconclusive pain management was as good as we can get it we tested for everything so ultimately we discharged the patient from the hospital you know of course this patient is on my mind for some time afterwards and so i caught up with the hospital provider who i worked really closely with and said hey whatever happened to this patient and the story goes the patient was admitted to another nearby hospital for the same problems and it was found out that they were under the covers of the blankets opening up the ports the hubs on the end of their pick line undoing the clamps and taking off the hub cap that we put on there and sucking the blood out of the pick line swallowing it and then throwing it yes okay that was my guess he was drinking blood he's an auto auto vamp where do you think he was getting the initial blood from before the pick line that's a good question i'm not really sure i don't know if they had any injuries i don't know any of that maybe been collecting blood over time and is the theory that this person was moon chosen or a drug seeker i have a feeling that at this point in time this was this patient's solution to getting to withdraw if i would have known now what i knew back then my approach with this patient would have been totally different you know thanks to learning from you guys over all this time and making sure that hey yeah this is a real thing and it's really hard i wouldn't have changed how i cared for their pain what a patient says their pain is is what they say it is if you're wrong someone's suffering greatly because you know everything then you're gonna feel terrible about that so you gotta live with it it's like the justice system some guilty people are gonna get away with it you know that's preferable right it'd be preferable to suck the blood out of your pick line than to deal with the detox it's pretty powerful yeah that speaks pretty greatly to what they're willing to do for sure oh wow but yeah that's my craziest story on how my patient they're blood oh my god that is horrifying kelly this has been a delight and anyone who has you as a nurse is so lucky and a teacher thank you i have to of course shout out my husband and my kids who we listen to armchair anonymous together great my husband's not necessarily a podcast person but he's totally hooked and the kids are 12 and 10 and we do a lot of uh teaching with them it's a great conversation starter yeah yes exactly a lot of pausing okay what questions do you have about this but they do not know i'm doing this oh say hi mom they'll hear my voice i think and they've been telling me to submit for a long time do you have a story mom do you have a story yeah i sure do of course i do well i want to say to both the little ones that were so delighted to be here with you today thank you so much for having me they're listening definitely whether it's ethical or not i won't decide i let my kids listen so you know we're all burning hell together i guess so yeah if anybody wants to judge us you know i just say well dax does it they seem to be attending they're learning it from me rather than on the school bus or at school i heard all these kind of stories on a playground with just no context or anyone explaining what was really going on yeah exactly exactly they will not be the kids that grew up to put anything in their butt that doesn't have a base on it exactly cautionary tale or if they do put a tether on it you know if we've learned anything make sure you can get it out it needs a tether and all wise yes you can't go out of town there's a lot to learn from this and be realistic in what fits in there we've learned but some things are too small they get lost it's a real fine line dildos exist for a reason i guess is the moral of the whole story like they there is a perfect size i'm sure some have gotten stuck oh sure i'm sure yeah well i'm glad we could send this into the ditch right at the end lovely meeting you and i'm delighted the whole family will be listening we're sending love thank you so much this was so fun all right take care bye bye hi there hi do you have a fake name that you're drawn to anything you want to use well you look like a cherub i don't know where we go with that angel angel boom really good job okay you can do that angel where are you currently in florida but this story takes place in the southwest okay great i love the vagueness this promises to be juicy we love this prom morning picking arizona okay she can't yeah we're not gonna say but just i'm already feeling arizona it's a wild place arizona there's a lot going on yeah there's a lot of things happening so are you a nurse i presume yes i am a nurse okay and how long have you been a nurse nine months oh my goodness okay wow congrats how are you liking it i love it it is the best ever some challenges for sure but it's been a great experience i'm very excited i imagine it's just an exciting job everything's different it's never stops yeah and the co-workers are great everyone you work with is lovely and wonderful you guys are the best we got okay so you have a crazy nurse story and we want to hear it okay so i'll set the scene i graduated in december with my nursing degree i went to school in arizona you were right okay funny to another state in the states i went to a large teaching hospital where everyone's brand new there's new doctors new nurses knew everything pretty much and the beginning of the year is hard because a lot of people are transitioning into new jobs. So there's a lot of change, but I'm going through orientation. It's about four months. And so I get off orientation around April and I've been off orientation two weeks. It's going great. I love everything. My patients are wonderful. The other thing to know is when you are a new grad, they give you the easiest patients usually on the unit. Yeah. Dip your toe in and then build your confidence. So great and easy. And you're like, yeah, it's great. And then it gets worse. So I'm getting report on these patients. It's my first shift of three. The last patient that I get report on, they're telling me like 50s male. He is one day post-op. He had his penis removed. Oh, okay. That's a bombshell. Let me go meet him. Let me go say hi. And so I pop in and he's sleeping. So I'm like, oh, I'll come back. I get the rest of my report. And the nurse is telling me, she's like, well, he left a cock ring on. Oh my God. And it went gangrene. For three weeks. No. Wait, why? Oh, he just loved it. Or he couldn't get it off maybe. Yeah. He could not get it off. Wow. Good for him. Good for her or him. Wow. Oh my gosh. Okay. How small are these cock rings? Well, I think they come in different sizes. So I think you're supposed to get one appropriate to your shaft size. But you want to just squish it. You squeeze it. Well, because all your penis is doing to get hard, right, is it's restricting the blood that can come back out. It's filling up. All these vessels are just keeping it harder. I think you get increased size with it. I'm going to be very candid. I've not ever worn one. So I'm speaking on theory. Yeah, yeah, yeah. I'm just guessing what's going on. Okay. Oh, so he got a child. But I know this. Well, let me say this. This is what I heard early on from a dude who I knew who was a male stripper. And he said the thing the male strippers would do is they would tie a bit of string at the base of their shaft or a cock ring because they're at work for whatever, six hours dancing and they want their penis to be. Oh, wow. Okay. Oh, my God. Well, don't do it. Now we know. So I'm getting report my jaws on the floor. And I'm like, well, what happened? Like, how was he found? Did he just walk in with this? And he was found by his friend that he like lives with some sort of social situation. He was found down and his friend had thought he had overdosed. And so he's like calling 911. They bring him in. They're treating it like an overdose from his house to the hospital. Comes to the hospital. They take all his clothes off. And they're like, don't think he overdosed on anything. Don't know. But we have other problems here. And they're like giving him some fluids. He's kind of coming to. And I guess they got consent downstairs. They're like, look, we don't want to take your penis, but it's not looking good. We can try this like vascular procedure. And he's like, okay, let's do that. Really quick. Was he sepsis? Is that why he was unconscious? Partially that, but also like his urine's backing up because he's not able to get any urine out for how long again? When I talked to him later, he was saying he's like, I had like a full stream of pee for like the first week and a half. And then after that, it was like, oh, mama mia. Papa Pia. Oh, wow. So they take him for that procedure. He wakes up the next morning on our unit and I'm getting this on report. So she's telling me like I had him and it just looked bad. It was black. It just didn't look like it was going to survive. And so the search comes in and he's like, look, we have to take this. We're going to remove your penis today. Oh my God. What a sentence to hear. Also, let's be clear. This man is an active man. He enjoys his penis. He's got cock rings on. And so I'm getting him the day after he just had his penis removed. Oh boy. And I walk in and I'm prepared for like emotional. Let's have a conversation. This is really challenging. I'm so sorry. This is going on. Let's talk about this. And he's like, oh, I'm doing good this morning. You know, I'm not having a lot of pain doing really well in report. I got that. We had to change the dressing every two hours because they rerouted his urethra through his scrotum. Oh, okay. Cause he didn't want to have a like suprapubic catheter. He didn't want a bag external of him. Well, that was like the agreement he came to with the urologist of like, we can try it, but it may not be a thing. And so his urine is draining out of his scrotum. Wow. Hold on a second. I'm just trying to like really model what it would feel like to grab my ball sack and aim it. You'd have to aim it. Well, sure, sure, sure. Or you stand at an angle. You might want to sit, you know, cause they're going to droop downward anyways. Okay. Wow. That's an adjustment. Urinating through your balls. So does he have a catheter through his urethra that is in his ball sack? No, it is just his urethra coming out. Okay. All right. Modern medicine. They can do anything. I want to have mine run out the palm of my hand so I can just like pee out the window and stuff. Am I driving? Wouldn't that be convenient? But it's leaking there. And so I'm pulling back this dressing. It is sopping wet. I pull it back. Take out the packed gauze that's in it. And it is like a baseball sized gaping hole. Where his penis was or in the testicles? Where his penis was. They dug it out. I'm taking the gauze out and I'm like, I don't think this is how we're supposed to be dressing this. I need to call a nurse or nurse. I need help. Were you conscious of your face? When I saw it, my next thought would be like, Oh, control your face. God knows what it looks like right now. I think I was like trying to, cause I was like, I know it's going to look rough. Let me like try and keep a straight face. Are you wearing a mask? Yeah. Okay. Thank God. Yeah. I have another nurse with me. We're looking at it together and she's like, you should call wound care. She's like, I don't know what the surgeon said. I don't know what they want. And so I'm like messaging back and forth with wound care. And I'm like, Hey, I just want to make sure we're doing the right thing. I don't want to make this worse. It's a really wet wound. He has urine around it and that doesn't seem great. Yeah. Although isn't it antiseptic? It sounds like a grenade went off in his underwear. I mean, that's what it feels like we're left with. And the whole time he's just casually talking to me. He's feeling a great mood. What a champ. Yeah. I'm like, this is impressive. Okay. So wound care finally shows up. They come in and we are going in there and they're like, Oh, this looks great. This is exactly what you're supposed to be doing. This looks great. This is gorgeous. I'm caring for him over the next couple of days. And it's kind of the same stuff. He doesn't look great. Like his hemoglobin is a little low. So he's a little pale and I'm like, Hey, don't get up. Don't get out of bed. So he's like stuck in bed with this wound, tough spot to be. And he's kind of lonely. And so I tried to go in there when I have time and just like chit chat with him. I'm always asking patients. I'm like, Oh, where'd you grow up? Are you from here? And he's like, well, I'm not from here. I lived in Arizona. And I'm like, where at? He tells me where he was at and where he's working. And he worked on the same street I grew up on. What? No way. That is so sad. I got to say, cause it keeps burbling into the top of my mind, which is this also sounds very meth-y. People with these kinds of injuries, we learn generally meth is involved. Does it go weeks with this condition? Well, and a friend thought he overdosed. Yeah. What if the punchline was that you found out this was your real dad? Oh. Oh God. Tell us about a meet ugly with your biological dad prompt. Okay. So he worked on your street. Yeah. And so I'm just talking to him about that. And we're like building rapport. And finally I ask, I'm like, so what were you doing about this? What was the situation at home where like this is staying on? And he's like, well, I was like going to work and then I come home and I try everything I can to get it off. And he's like, do you want to see a picture? And I'm like, Oh no, I do, but I don't know if I'm allowed. Okay. Oh God. I would have said yes to. I know, but all right. Ooh, yeah. This man is creeping me out a little bit. Okay. He sounds friendly though. Exactly. He just got his penis cut off and he's too happy. He's probably like, finally, this is over. God, I'll finally have some free time. Monica's definitely on the money with a little bit creepy, but he shows me and it is just like a black little shrimp, silver ring around it. A shrimp? Oh fuck. Oh fuck. God. So he's a metal ring. Well, I didn't know people were putting, that's a bad idea. That makes sense why he couldn't just like cut it off or something. This is like my second or third shift. I have some time to like look through notes and I'm looking through his notes and he had come in with a similar injury the previous month. And in the notes, it's like was left on for three days. Couldn't get it off. So came to the hospital and there's like very clear that like education was given to not do this again. He couldn't resist. Ew. But then why do you wait this long? This time? It's a good question. Maybe he felt like they really shamed him on that last trip. He's like, I can't go back and admit I did this a week later. Couple weeks go by. I'm like working, but I don't have him as a patient. I know he's on the unit, but I don't really take care of him. And we're sitting in huddle and that's when we were just getting information about what's going on on the unit and like what patients to watch out for. And we hear the code alarm go off. Everyone goes in and day shift and night shift are both there. In a code, there's already a lot of people, but this is like double the number of people that are there. So there's like 30 people in a tiny hospital room, all trying to do something. have roles assigned. And so I'm like standing in line to do compressions because he is unconscious. He had had some other like GI bleeding just from being in the hospital and just some other like complications with that. He had been back and forth to the ICU a couple of times, woke up, came back, sent him back to the ICU. And I thought that was going to be my time with him. A couple of days later, I come back to work and I'm getting report. And I'm like, I know this patient, very familiar. She's like, oh, he's going to go home today. And I'm like, oh, phenomenal. Yeah, that's wonderful. And so I'm like, well, does he have a ride home? I go in the room and I talk to him and I'm like, hey, I hear you're going home today. That's great. I'm so excited for you. Do you have a ride? It can take a couple hours for us to get our stuff together. So just be patient. And he's like, oh, yeah, I have a ride. It's my roommate, my friend. And I'm like preparing my teaching discharge education. I go to my preceptor who happens to be there. And I'm like, hey, what would you educate on? Because like the problem that he came in with is gone. Right. What do you want to teach about? And she's like, maybe let's talk about not putting things in your holes, because that's the next step. That's where this is going. Now he has an extra hole. And she's like, make sure you explicitly say do not put anything in your urethra. OK, great. It became the roommate's problem. Oh, the roommate. Yeah, I hope he's getting reduced rent. I hope the roommate is actually like a boyfriend or something, because if it's just a roommate and you have to live with that, they need to call in a bad roommate. Yeah, I mean, I'm trying to imagine if like Aaron, through this whole scenario, what my reaction would be. Yeah, but you guys are best friends, not just roommates. But even as best friends, I think I'd be like, brother, what's happening? Yeah, of course. You'd inquire. But you'd probably still pick him up. Well, of course they'd pick him up. But I would just be like, what happened here? Let's talk. Yeah, we have a cave now. Oh. And a testicle penis. Wow, that's wild. On your first day. Angel, what a harrowing first shift. That was quite the first. First shift. That was incredible. Yes. Thanks for sharing with us. And yeah, I'm so happy you're doing this. Yeah, I'm so happy to be here. Can I give two shout outs? Yes. One to my mom. She is lovely and excellent and my favorite person. One to my best friend, Kaya in Oregon. She's excellent. And I hope she listens. Kaya, we hope you listen. Tune in Kaya. If you can hear us by passing a radio. Well, thank you so much for telling us all that. Yeah, have a great day. Thank you guys. I appreciate it. All right, take care. Hello. Hello. What should we call? Well, I know what I want to call you, Monica, on three. One, two, three. Chris. Yes. You guys can call me whatever you want. Do you get that all the time? I have gotten that one as a doppelganger as well as Donald Gleeson, the eldest Weasley brother. Oh, wow. The oldest Weasley brother. Monica, you would know better. You would know better than me. Is that a match? I mean, I think it's more on the Chris Martin front. Also, Chris Martin is such a sex symbol. Oh, yeah, he is. That's who you want to be told. I would love to be told I look like Chris Martin. Where are you, Chris? I'm in Oregon at the moment, but the story is in the inland Pacific Northwest. And are you a nurse? I am. I'm also a nurse practitioner. I kind of do both. What's the difference between those two? Nurse, you work at bedside. Nurse practitioner, I have prescriptive authority and I can see my own patients. More school, it sounds like. More school. I have a master's degree. Okay, great. And how long have you been doing this? I've been a nurse for almost nine years now and a nurse practitioner for almost two. And are you still loving it? Yeah, it has its ups and downs. I think there's days like this story that attests to you. And then there's really fulfilling days where, you know, you made a difference in someone's life. I got to say that's every day that you guys go to work, you make a difference. Yeah, absolutely. You know how we feel about nurses. We're like, how could someone be superior? You know, through a lot of therapy, I think the amount of nurses that have their own trauma, some people kind of maybe turn towards drug addiction or substance abuse and then others turn into caretakers. Yeah, that's really true. I think you're right because I think there's a high arousal setting for most people in nursing. Definitely. And probably a decreased amygdala response. Okay, so you have a crazy story. We want to hear it. Honestly, when I emailed Emma, I was like, there's no way. There's no way they want to put this on the air. It's crazy. Oh, that makes us so excited. Well, just to tell you, Chris, we did just hear about someone that had two areas of necrotic flesh in their perineum. And it looked, the nurse said, like honeycomb. And in total, there were thousands of maggots. It filled up two liters. That one's on the program. Fournier's gangrene is what they call that. That's the rotting of the perineum. Oh, you're like, I've been there. Oh, my God. You guys have all done all these crazy. Oh, my God. It's wild. Okay, so this story takes place in the inland Pacific Northwest. And I had been working at this hospital for a couple of years. And after you work there a while, you get to rotate as a trauma nurse. So you have to have a certain level of tenure. And so that means like when the ambulance calls and something crazy happens in the field, you go down to the ER and you respond with an ICU doctor, ICU nurse, ER doctor, ER nurse, and the trauma surgeon. And so sometimes when you're waiting, they get downgraded to partial traumas. And then you just go back to the unit. But sometimes they can be crazy. But you get used to it after a while. Nothing really surprises you. This one did surprise me. So we were all waiting in the trauma room. It was the five of us. And we had massive transfusion blood set up. So like this thing called the Belmont, which just pushes blood into people. And then vasopressors, medications drawn up. We're all just waiting. We're waiting to see what comes through the double doors. And so dispatch comes up with an update. It says stab wound, disembowelment. Oh, boy. Okay. Okay. So then Amar calls in and gives us this story. An 87-year-old woman called 911 because her son, who lived with her, was in his mid-50s and had apparently stopped taking his psych meds. And she walked into the living room, found him sitting on the couch calmly smoking a cigarette. And he had cut his abdomen from side to side, pulled out his intestines, and put them on the couch next to him. No! Oh, my God. Oh, fuck. I haven't even seen that in a horror movie. Yeah. And he was conscious smoking a cigarette. Real quick question. When you hear that there's a psych element to it, do you now have to bring on other additional people like psychiatrists who are going to help stabilize? I mean, I guess you can't stabilize someone mentally that quickly. So after they get admitted and stabilized, then you'll have inpatient psych come see them and deem whether they're. a threat to themselves or others. But that doesn't happen immediately. At this point, we're just trying to do life-saving measures and get them to the OR as quickly as possible. But yeah, oftentimes that will lead to restraints in the hospital and mixed thoughts about that. But you have to protect someone from being a harm to themselves. So paramedics got him in the ambulance. He lost consciousness on the way to the hospital. And then when they wheeled him into the trauma bay, one of the paramedics handed me his intestines and his Ziploc bag. In a bag? Wait. They were now separate from his body? Oh, yeah. He had, like, ripped them out. Oh, my God. I can't believe he hasn't blood to do. I know. It was close. We gave him, I think, about six units of blood before he got to the OR. The paramedics were like, "I don't know what the hell you're supposed to do with these." Ha! Make chitlins. Oh, my God. But he got it to the OR. He got a colostomy, so, like, new plumbing, you know, pooping out of your stomach. And I went home. That was my Friday. And I was like, "That was the craziest." The craziest shift ever. I figured he had been discharged or downgraded by the time that I got back to the hospital. He was not. And then that day, it was, like, three days later, and I was floating as, like, helper nurse that day. And so you just kind of walk around the ICU and give people breaks and help turn patients or help where it's needed. I was across the unit, and I heard someone yell, "Help, please." And so I ran over there, and this guy had been in restraints. He broke his restraints, and he had grabbed both of his testicles and de-gloved them. Wait, wait, wait. Say that word again. De-gloved them? He took off the skin? He pulled the insides out. Oh. Wait, I don't even really understand what that means. Hold on. He pulled the insides. So he pulled the testes themselves out of the scrotum. Oh, my God. Did he have to cut his own scrotum? Yeah. Or did he go in through the big incision that had been made for his bowel work? No, he just grabbed them with his bare hands and jerked. Oh, my God. This. Oh, my God. Oh. Oh, Daddy. This. Wow. This guy's good for two unbelievable stories in one person. He's just trying to take out everything. He needs it all. Everything must go. Yeah. Spring cleaning. He was totally calm, right, which was an element of psychosis there. But I turned around. I grabbed some sandbags. We tried to pack pressure of the wound as best we can, but testicular wounds bleed rapidly. And unfortunately, this gentleman did not survive this. They bled out. Wow. Yeah. I've heard if you get castrated, you bleed out very quickly, like in minutes or something. Didn't they do a bit on that in Django or something? Oh, probably. Oh, maybe. Yeah. Yeah. That seems like a Tarantino topic. But as a nurse, you see crazy things. I've had good stories and bad. But this is one of the experiences that really changed my perspective of how I see suicide. And I think that I used to see it as a very selfish thing when I was a kid. I remember saying it was the most selfish thing. and it was like the most selfish thing somebody could do, but that was before I spent years in healthcare what i saw on that day was not selfish it was totally a mind at war with himself that's really chris i had the exact same thought when you said that i just thought yes some people really are not going to be in peace in any way and it'll be such a misery to exist that yeah it's actually more humane like you understand the reasoning behind it i've heard a couple people who have responded to public suicides and or overdoses as i'm so glad they're out of their pain and i think that's kind of a nice way to frame it yeah i think that's the empathetic way to look at as best we can i can't know what was going inside this guy's head sometimes people are hallucinating i don't know if that's what it was because on that second instance he had already been restarted on a psych at that point inpatient psych had seen him but it didn't look like panic it was calm and i felt like a rational decision to end his life but that said the illness had completely overwhelmed his brain and taken responsibility you one of the things that's so important to me is that i think it's important for his fear his judgment his self-preservation yeah we have some acceptance over an organ failing through a disease and in killing the person that we seem to accept that but your brain can also fail you in the same way an organ can yeah i think about there's funny parts of the ziploc bag and it's a crazy party story for when i'm hanging out with other nurses or health care professionals but i also think about like how much i misunderstood before i joined this job and so i think it's good for people to question what they once believed and look at things from another perspective we agree yeah oh wow chris that's a fucking yeah that's up there a story that's up there does remind me of the helicopter ride with this yeah yeah yeah i am sorry to make you guys ride i can see you both look uncomfortable no no weirdly we love it i know yeah thank you to both of you for the space that you guys have created you guys bring so many important things to the surface that people carry alone sometimes people don't want to hear them and getting to say things like this and other crazy stories it means a lot and you create a great safe space and also you talk about things like traumas you know for instance this gentleman the trauma that his mother went through sitting in the other room she couldn't understand and then how we maybe have different feelings about our parents and how complicated these stories can be and as we change and evolve how we can see more nuance and not blame people but go towards forgiveness and understanding and you guys are absolutely incredible at that and i thank you for doing what you do oh man chris thank you that's such a beautiful compliment yeah thank you really appreciate it thank you for doing what you do yes and congrats on looking like chris martin yeah yeah it's a big accomplishment i don't know if people are patting you on the back for that but it's it's something to feel good about we'll see as we age time may not be kind to us but it was really a pleasure yeah right back at you i'm so grateful that you're doing what you do thanks for having me guys and it was really an honor thanks so much have a good day take care what a sweet soul what in the world he was so special wasn't he yes yeah chris martin okay really when he popped on i was like oh my god chris martin is calling in i really i really thought he was gonna wow that was wow nurses they deliver literally and figuratively that's right they deliver babies right they deliver your meds we're grateful for them they deliver they deliver your intestines in a ziploc bag at times turns out turns out all right love you do you want to sing a tune or something a theme song oh okay great we don't have a theme song for this new show so here i go go go we're gonna ask some random questions and with the help of arm jerry's we'll get some suggestions on the flyer rhyme dish on the flyer rhyme dish enjoy