Bottoms Up To: Good Samaritans, Burn Patients & DIC

This week, we’re raising a glass to burn units, Good Samaritans, and the absolute disaster that is disseminated intravascular coagulation. From heroic saves gone wrong to the chaos that follows, we break down the medicine, the mess, and the moments that make healthcare equal parts horrifying and hilarious.

Transcript

SPEAKER_01 0:03

Paging Michael and Colleen. Paging Michael and Colleen.

SPEAKER_00 0:09

You're listening to Scrubs Off Bottoms Up.

SPEAKER_01 0:21

Hey everyone, welcome back to Scrubs Off Bottoms Up. I'm Michael.

SPEAKER_02 0:24

And I'm Colleen.

SPEAKER_01 0:25

Colleen's pissed tonight. Colleen, tell us a little bit about why you have a fucking attitude. Because you don't know how to shut your mouth. About? Would you like to go into detail with it?

SPEAKER_02 0:36

Literally anything. We're not getting into this. I don't think it's necessary. Because this is not what the podcast is about. It is about nurse life, okay? So, Michael, how was your week?

SPEAKER_01 0:47

Well, my week was great. I just obviously haven't changed, but um, I just got off work looking at lots and lots and lots of New York's buttholes. I love my life. It's fantastic.

SPEAKER_02 0:58

Oh, I love that you love my life. Amazing.

SPEAKER_01 1:06

Yeah, no, it's honestly a dream come true. Some would call it an ass connoisseur. Ooh. It's like a smallier. I love it. But I don't taste them, I help fix them. Okay. And help make them look a little bit more pretty, uh, aesthetically pleasing. Some would say. But yeah, it's been a great week so far. How about yourself?

SPEAKER_02 1:26

My week has been also great.

SPEAKER_01 1:28

Tell me more about it.

SPEAKER_02 1:31

Umys the crap out of me because I always say I worked. Okay, we all know. So from from here on out, I've worked.

SPEAKER_00 1:40

Yeah.

SPEAKER_02 1:41

Okay. Three days a week, once a month, four days a week. This week I'm working like seven days um because I'm taking a trauma class. I have to get certified. I have to be like certified trauma, whatever.

SPEAKER_01 1:54

Which Colleen going into at this point? She's like, I'm not even an emergency room nurse. I don't know why I need the TNCC certification, but I love it's very fun.

SPEAKER_02 2:03

It's a two-day thing, and the I learned so much today.

SPEAKER_01 2:07

It's great.

SPEAKER_02 2:07

No, I'm actually obsessed. And we do, where I work, we do get traumas. Actually, quite a bit. Um it's so it's it's very weird because where I work, we we get really everything. We don't have a neuro ICU, so we get all of the neuropatients. We don't have like it's half medical, half surgical. And so if you're not cardiac, which the CCU, CTICU takes very little pa, like they don't take anybody that does that has something more than cardiac.

SPEAKER_03 2:38

Correct.

SPEAKER_02 2:38

So we get everything else, so we see lots, and there's lots of like all the specialties kind of fight, which is so fun because I'm the middleman and I try to like be friends with everybody, and I'm like, guys, I don't know.

SPEAKER_01 2:51

But um, but for example, recently you had a John Doe who came in. Um those of you who don't work in healthcare, John Doe is an unidentified person, so they go by Jane or John Doe, and it was a patient who was hit by a train, correct?

SPEAKER_02 3:04

There's a lot, if you Google New York City, like train hits, um like people getting struck by trains, it happens all the time. It's actually insane how often it happens, and most of the time, I mean, I don't always walk around with my ID. So, like, if something were to happen to me on the street and I'm alone, like no one would know who I am either. I'm getting my.

SPEAKER_01 3:30

I would feel it in my bones if something happened to you.

SPEAKER_02 3:33

Yeah, you would.

SPEAKER_01 3:34

But also, you're so fucking loud that I feel like anyone who knows you would be able to hear you like a bat signal. Oh I'd scream. But what's crazy is so a couple years ago, I was down in Chinatown.

SPEAKER_03 3:44

Yeah.

SPEAKER_01 3:45

And I um they had closed down the Canal Street station, and I watched them bringing somebody up, and they had flail chest. It was not the first time I'd seen flail chest, but when I say it was like paradoxical respirations that turns out.

SPEAKER_02 4:00

Oh my god, we just had a whole simulation of this.

SPEAKER_01 4:03

Did you actually flail chess? This is wild. Can you explain flail chest to those who don't work in healthcare?

SPEAKER_02 4:08

Is two, what's the word?

SPEAKER_01 4:10

Asynchronous.

SPEAKER_02 4:12

No, synchronous. The the two ribs have to be broken off, like broken in a row. It can't be one here, one, like you can't just have like random ribs broken. It's two ribs broken in a row. And when you breathe, like you can just see them go out and then back in. Yeah, okay.

SPEAKER_01 4:31

So what I was getting at is like flail trusts that I've seen, ribs have been broken in so many different places that it almost looks like their breathing is asymmetric or asynchronous, like one side is moving while the other. It just looks like a mess, like a flaw.

SPEAKER_02 4:45

You know what that's called?

SPEAKER_01 4:47

You're gonna die?

SPEAKER_02 4:48

Fuck, it's on my test tomorrow.

SPEAKER_01 4:53

We'll get back to you, folks. Yeah. After Colleen fails her test. But as you know, we talk about a lot of things healthcare, and we don't always know the most about things in terms of healthcare.

SPEAKER_02 5:03

No, absolutely not. And that's the beauty of it. You don't have to- Constantly learning. I mean, yeah. I don't know why you have an obsession with vaginas recently. Michael has like a very big obsession with vaginas. And not anybody's vagina, my vagina!

SPEAKER_01 5:25

I don't know why. I just find it like so fascinating because a penis is a penis, the hole is the hole, that's where pea comes out, that's where semen comes out. Vagina, there's all sorts of it's like Pandora's. You wanna know why? Tell me.

SPEAKER_02 5:38

Because that's where life starts.

SPEAKER_01 5:40

Okay, I fucking hate that. Um but literally it's Collegiate and I was we're going through anatomy. Yeah. And it's you peel back layers, and it's like an onion.

SPEAKER_02 5:52

No, but it is because it has so many roles. And actually, like I'm starting to I'm starting to love vaginas.

SPEAKER_01 5:58

Are you? Because you're so you're afraid to touch your own vagina.

SPEAKER_02 6:02

I don't like vagina, I just don't like them. They're just like fair enough. Yeah.

SPEAKER_01 6:05

Um with that being said, I do want to talk about kind of something on a more serious note, and I see it a lot at the clinic I work at, but um, the Gardasil vaccine and HPV or human pathholomavirus, were you vaccinated with the Gardasil vaccine? Absolutely, yeah. So I don't do you remember the commercial back in the day with the jump rope? With jump ropes. And I feel like in our era, like if you're in your late 20s, early 30s or 30s, there was a huge push for women to get the HPV vaccine because HPV can lead to cancer. I don't think it was pushed nearly enough for men, and men are able to get the vaccine. Well, men don't have a cervix. Correct, but men can develop HP cancer.

SPEAKER_02 6:51

Wait, that's what it is. Cervical cancer, right? Correct.

SPEAKER_01 6:54

Okay. But essentially, this virus can create human papillomic warts on genitalia or the ass or asshole. And if men are not vaccinated against it and they have an outbreak, they develop these warts kind of over the entire area. And what are the warts? What the well, they can be painful, they can be very irritating.

SPEAKER_03 7:12

Oh, well, that's why.

SPEAKER_01 7:13

A lot of the time we have to go out and like surgically remove them. And so we see a lot of patients. So I wanted to take this time to like educate on the HPV vaccine, and you're able to get it at any age if you're way past the age of like your teens.

SPEAKER_02 7:27

That's actually crazy because I didn't know. Well, I knew men could get it, but I did not know there was any effect of men having it. Like I thought they were just the carriers.

SPEAKER_01 7:38

No, so men can actually have these outbreaks. No, I know.

SPEAKER_02 7:40

Well, I mean now I know.

SPEAKER_01 7:41

I just think that it's like not educated enough on, and it's something that we educate heavily on in our practice, but unfortunately a lot of the time it's patients are unaware if they have it, and then they have sexual intercourse, or they're doing like something like laser hair removal or bleaching in their like genital area, and then they come out with these HPV outbreaks. And then if it's out.

SPEAKER_02 8:00

So wait, were you given the option to get the vaccine as a kid?

SPEAKER_01 8:07

I that's a really good question. I was gonna ask my mom and I need to pull like my pediatric charts and see if I actually have it, but if not, I 100%, especially now that I'm single in New York City, I will 100% be getting revaccinated.

SPEAKER_02 8:18

And we'll make sure he's vaccinated ASAP, okay, everybody?

SPEAKER_01 8:21

A-S-A-P. Um, okay, enough on that rant about.

SPEAKER_02 8:25

I gave him my first tetanus shot the other day.

SPEAKER_01 8:27

Did you really?

SPEAKER_02 8:27

I had never given a tetanus shot.

SPEAKER_01 8:29

Why did you give it?

SPEAKER_02 8:30

Um, it was like a trauma that came in. Okay. Trauma. Trauma? I'm honestly a trauma nurse.

SPEAKER_01 8:37

Okay, I want to go down another rabbit hole really quick. Of what? About um medications and something like a tetanus shot. I don't know why I was thinking of tetanus as a PPD, but I'm gonna go down this way. So I work in aesthetics, obviously. I do aces most of the week, but I also contracted a meds fondue faces, Botox, filler, PRP, blah, blah, blah, whatever. So we can we have the ability to dissolve hyaluronic acid-based fillers. So let's say somebody comes in with like super botched lips or they hate their lips that have been done.

SPEAKER_00 9:07

Kylie Jenner did it.

SPEAKER_01 9:08

We have the option to dissolve them. It's painful, we dissolve all the time. What I recently learned is Hylenex, which is a brand of hyaluronidase. Slow down, you're losing me. So hyaluronidase is the enzyme that we inject to break down hyaluronic acid-based filler. And hyaluronization. The brand is called hyalinex.

SPEAKER_02 9:26

And most filler is made with hyaluronic acid.

SPEAKER_01 9:29

Most. Okay. We're just gonna leave it.

SPEAKER_02 9:30

But we're gonna say general, because I'm dumb.

SPEAKER_01 9:32

I found out that one in 2,000 people have a reaction to hyaluronidase. Hyaluronidase is also only Which is the dissolver. Correct. So it is actually recommended, and this is not educated on many places at all, is to do if you have any sort of reaction or history of anaphylaxis, bee stings, cow allergies because it's derived from bovine, is to actually do like a PPD on the arm and wait 30 minutes because one in 2000 will develop angioedema from the hylodex to dissolve the filler, which angioedema is like facial throat, tongue swelling, which can obviously compromise your airway, and you can die because you can't breathe. Whoa. So slow. So, also interestingly enough, your body actually the cycle of life, I learned, oh my god, starts out with hyaluronidase. How it's when the sperm- The cycle of what life? Human life.

SPEAKER_02 10:29

Pre-vagina life.

SPEAKER_01 10:30

Correct. So when sperm enters egg and implants, it releases hyaluronidase to enter the egg and imp impregnate. You get what I'm saying.

SPEAKER_02 10:43

Yes, yes, yes.

SPEAKER_01 10:44

So the same thing that brought you into this world could take you out. One in 2000.

SPEAKER_02 10:48

Okay, so why is there a problem now?

SPEAKER_01 10:51

Because it's derived, from what I understand, is it's because it's derived from like animal products and it's it's like bovine, it's a derivative of bovine, which is cow. Um, anywho, long story short, I found that very interesting and obviously like changed up my.

SPEAKER_02 11:07

So here's what I got from this is if you go get filler, you get it dissolved, and you have a reaction, you can blame your parents, and it's not your fault.

SPEAKER_01 11:18

Great, sure.

SPEAKER_02 11:19

And then they have to pay for it.

SPEAKER_01 11:21

They have to pay for your ER bill.

SPEAKER_02 11:23

Your filler for the rest of your life. Okay, fair. I'm just saying.

SPEAKER_01 11:30

Education. What route hole were you trying to go down?

SPEAKER_02 11:32

Well, I was going to go. Okay, I have Oh god. Two things. Okay. When I was thinking of trauma, I've always been nervous of being in the situation to have to be a nurse on the outside of the hospital because I know how I'm not a trauma nurse. I'm I was a tele-nurse, like, I need some monitors, I need like XYZ.

SPEAKER_01 11:55

It's the good, the good Samaritan. It's something has a medical.

SPEAKER_02 11:58

So, like, I never want to like run up and be like, I'm a nurse prior to being now in the ICU. Now I feel more comfortable because I have the training and stuff, but and being in New York City, honestly, because you get crazy stuff. Of course. And a few weeks ago, my biggest fear came true. My biggest fear came true.

SPEAKER_01 12:19

I She was the first responder, ladies and gentlemen.

SPEAKER_02 12:23

I was the first one there. I was the first one there. Which, like, normally, okay, I can be like, hey, I'm a nurse, you need me help. They could say no and you call it a day. Like, I've had that happen many times. The fire department's there, ambulance is there. I'm like, they don't need me. I feel good about myself. I don't know. I am driving home. I am vlogging someone or audio messaging someone. Yeah, I call it. Yeah. And I'm messaging and I'm like, do talking, talking, talking. And all of a sudden, and I saved it. It's so funny. I go, oh my god, oh my god, oh my god! I scream. I'm looking at on the opposite side of the Merritt Parkway, which is a two-lane highway going each way, very, very slim lanes. Okay.

SPEAKER_03 13:08

Okay.

SPEAKER_02 13:09

I'm looking at a car on fire in in new flames, like fully fire fire. So everybody's slowing down and looking, and I'm having a freak out. I drop my phone, obviously, and I pull to where like you're gonna get off the exit. And I'm like, what the freak do I do right now? Like this horizontal. So I I pulled over. Luckily, I was manic. So luckily, like everybody was going slow. So I cross over the two-lane highway to the middle, like the median. Uh-huh.

SPEAKER_00 13:46

Uh-huh.

SPEAKER_02 13:46

And I'm like looking, and I don't know what I'm gonna do. My life would have changed if I saw someone on fire. You know what I mean? Like, I didn't think about that. So I'm looking in the car and I'm looking for humans. I see no humans, except I see one man standing in the woods on the on the other side. Okay. And no one is stopping for this man. Like, not like you're gonna do anything, but what if you had a kid in there? Okay, like you can give him a hug. I don't know, like whatever. So I yell over to the guy. I go, hey, is that your car? And he goes, Yeah. I'm across the highway, I'm on the median thing, like screaming at it. And I go, Are you okay? And he goes, Yeah, I think so. And so I go to like go over the median because I locked my car, I have my keys. I go to go over the median, and the flames start like, you know, new fire that starts like having little bombs.

SPEAKER_01 14:38

Oh, yeah, like little.

SPEAKER_02 14:39

It starts being like, and I was like, oh my goodness.

SPEAKER_00 14:43

Call my normal baby.

SPEAKER_02 14:44

I'm not doing that. So I run back to my car, cross over the highway again, and like people are beeping at me. You're just frogger. Screw you guys. Like, can anybody stop? I go off the highway, I cross over to go the other way because I had passed him just a little bit, uh-huh, and still no one was there. There was no police officer, there was no fireman. So I pull onto the freaking um grass and I get out and I go, I'm like, hey, what happened? Is everything okay? He's like, it just started smoking, yada yada yada. I'm like, is anybody in that car? He's like, no, it's just me. I'm like, were you in that car when the fire started? And he said he had like gotten out first. Right. And then he started crying about his life, and then the cop showed up, thank God, and I said, I need to go.

SPEAKER_01 15:32

So that was your good Samaritan act.

SPEAKER_02 15:33

It was.

SPEAKER_01 15:34

Well, congrats. I'm happy that it wasn't like a traumatic experience of having an impulse in the end of a car.

SPEAKER_02 15:39

Shook though.

SPEAKER_01 15:40

Um, that's wild though.

SPEAKER_02 15:42

I felt really good about myself.

SPEAKER_01 15:44

Good. You should have. You like acted appropriately, you like turned on nurse trauma mode and like fucking ran.

SPEAKER_02 15:50

Going about What do you do about that?

SPEAKER_01 15:53

I don't know. I genuinely don't know because I don't think I would risk my own life to pull somebody on fire out of it.

SPEAKER_02 15:59

If there was a child in there, I think I would.

SPEAKER_01 16:02

Um, okay, let's talk burns. Have you ever worked in a burn unit?

SPEAKER_02 16:05

No, it's not my type of thing.

SPEAKER_01 16:07

So I do want to shout out somebody that you and I both know. And I hate it, Olivia. Olivia, we know you're listening because you are a tried and true sober listener. Um, the amount of respect that we have for you. So Olivia was a travel nurse who worked with us where I met Colleen.

SPEAKER_02 16:24

Yes.

SPEAKER_01 16:25

I take this as such a compliment. Everyone would, but um, people used to confuse Olivia and I. Olivia is this tall, beautiful woman with bleach blonde hair that looked very similar to mine, and we sort of like carried ourselves similarly. I probably carried myself a little bit more gay, but um, we looked similar enough to where some patients would confuse us. Anyway, Olivia left New York and is working in a burn ICU, and I have so much respect because I couldn't fucking do it.

SPEAKER_02 16:54

I can see her there. You have to have like such a s kind soul. Like that girl is one of the smartest people I've ever met.

SPEAKER_01 17:02

Incredible nurse.

SPEAKER_02 17:03

And also is just so what's the word?

SPEAKER_01 17:06

Olivia, you're hot. Also, Olivia's hot recently, I think they posted it online. I'll edit this out if not, but recently engaged. Congratulations, Tina and Olivia. Uh, we're very, very excited for you. But also, thank you for all the hard work you do because working in a burn unit is not something I could do. Actually, during COVID, I took care of a patient when I was on contract in Alaska, and it was a young, young guy. And he had somehow, we didn't know if it was domestic violence or not, but there was a pot of boiling oil that spilt from the back of his head all the way down his back. So he I wanted to say he had like 30% covered in burns and like very severe burns with his body. That's a significant area. Yeah. So do you remember the Parkland formula from nursing school?

SPEAKER_02 17:56

I don't even know what you're talking about.

SPEAKER_01 17:57

It's like burn resuscitation where you like how it's a number of hours times the basic ways. Yes, yes, yes. And it's how much fluid you basically try and get in somebody to resuscitate them post-burn. Whatever. There's nothing I can do about that. So Alaska doesn't have any like legitimate burn units. If you're over, I want to say like 20%, you get shipped out to Seattle. Well, surprise, we're mid-COVID. Seattle's ICUs are closed, so we were taking care of a burn patient that we were not fully well equipped for. Anyway, this guy was there for a while. He ended up getting COVID, blah blah blah. I mean, the story's actually awful, but he survived the burns. We like took great care of him. He went for like a final like um grafting procedure for one area on his body. Died. Died.

SPEAKER_00 18:40

On the table, threw a fucking clot from COVID.

SPEAKER_02 18:44

Okay, let's talk clots.

SPEAKER_00 18:46

Let's let's talk clots. Call each other.

SPEAKER_02 18:49

Are my biggest?

SPEAKER_00 18:50

Clots are terrifying.

SPEAKER_02 18:53

Literally, what are the kids? Blood clots are my op.

SPEAKER_01 18:58

Like what the fuck does that mean?

SPEAKER_02 18:59

It's what the kids say. They call them op.

SPEAKER_01 19:01

Is it like Riz?

SPEAKER_02 19:02

No, it's like your opponent, maybe? Op.

SPEAKER_01 19:06

Okay, that's like your op. Dumb as shit, but continue.

SPEAKER_02 19:09

Blood clots are my op. Like they scare the shit out of me.

SPEAKER_00 19:15

Yeah.

SPEAKER_02 19:16

And we've talked about this before. That's why I take an aspirin before I get on a long flight. And because, you know, I don't walk around. I slow.

SPEAKER_01 19:23

I mean, there are so many different types of blood clots that you can have. What's your what's your favorite? None. No, no, no. What is your what are you scared of the most? Give me a condition or a type of clot.

SPEAKER_02 19:35

You want to know my biggest fear?

SPEAKER_01 19:36

Saddle PE is scary.

SPEAKER_02 19:38

You want to know my biggest fear?

SPEAKER_01 19:39

Tell me. D I C.

SPEAKER_02 19:41

D I C D I C And I thought it was fake until about three weeks ago.

SPEAKER_01 19:44

Nope. D I C COVID. COVID is.

SPEAKER_02 19:47

I mean, D I C is fake.

SPEAKER_01 19:49

I'm sorry, what?

SPEAKER_02 19:50

I'm putting it into the world because I hate it.

SPEAKER_01 19:52

Oh, D I C is the worst. So D I C is disseminated intravascular coagulation. Essentially micro clot every time.

SPEAKER_02 20:00

Can I tell you something? I so a lot of patients in the ICU develop. Go into DIC.

SPEAKER_00 20:07

I see, yep.

SPEAKER_02 20:08

And usually when it happens, it is not a good sign. It is a very, very bad sign. However, I have seen a lot of people recover, which I was not expecting because I thought it was fake. But I was working with this kid the other day, and I was like, you know, just going off about one patient, just like talking, and I'm like, and I can't believe he like got better, yada yada yada. He went into DIC and he was like, oh my god, he got dicked. And I go, Oh my god, I've never heard that before. And he goes, Why didn't we think of that in nursing school?

SPEAKER_01 20:44

Like because I feel like the first time I really heard about DIC was in COVID because a lot of COVID patients were going into DIC.

SPEAKER_02 20:50

Yeah.

SPEAKER_01 20:50

I had so many nasty codes and like intubations with patients, and it was like, oh, I remember we But did DIC make sense to you? Yes.

SPEAKER_02 21:00

Oh, not me.

SPEAKER_01 21:01

But it's also like they're so tight. It's confusing. I've also had patients like essentially like internally hemorrhage because of DIC when in COVID and then like tried to intubate them. And I remember like one time screaming I was like, the patient's in DIC, the patient's in DIC, and they went to like intubate the patient, and they just like blood everywhere. Bled and I vivid memories of like I hooked up the yankers, bilateral yankers or suctions to clean up postmortem because there was blood everywhere everywhere. Rest in peace to that patient.

SPEAKER_02 21:31

But um rest in peace to all patients.

SPEAKER_01 21:33

That is like the first time I heard about it. But yeah, clots, scary, blood clots are scary.

SPEAKER_02 21:38

I used to work on a stroke unit. So we used to like clots just really scare the crap out of me. No, yeah. I used to like work. When I was young, when COVID happened, I was like, I'm gonna get my D dimer checked. And then my mom looked at me and she said, You don't need to get your girl, what are you gonna do if it's high? What are you gonna do? And I said, That's a no, I'm not.

SPEAKER_01 22:01

So I worked with an aide who got COVID during COVID, and he ended up having to be on Seralto for like two years because he developed like a really bad DVT or something.

SPEAKER_03 22:09

That's another thing that scares me.

SPEAKER_01 22:10

Yeah, so when I try when I worked FedSide, I should probably go back to doing it. I wore compression socks. Tell the circulation. When I fly, you and I should not be over the counter drugging ourselves, but we should be um getting up every couple hours.

SPEAKER_02 22:24

Okay, let's buy SCDs for the airport.

SPEAKER_01 22:28

Okay, getting off a little bit of like the hospital and nursing topics.

SPEAKER_02 22:34

Sorry, we just like went. We went on a fucking week. I'm very into nursing right now. You really have to be able to do that. This week, I am I've had the best, I've had very good things happen this week with nursing. I love nursing. I mean, I love it all the time. I very rarely dislike my job. Uh-huh. However, I've had such a good week with my patients and such great things happened.

SPEAKER_01 23:02

Then why were you in such a shitty mood tonight?

SPEAKER_02 23:04

Because you pissed me off.

SPEAKER_01 23:06

Tell everyone why I pissed you off.

SPEAKER_02 23:08

No, I'm just kidding. Um, why was I in such a shitty mood today? Because I am stressed, okay? I take a lot on. I take on everybody.

SPEAKER_01 23:21

So let me ask you, what do you do to release your stress?

SPEAKER_02 23:25

I go to the gym. And you try to convince me to not go to the gym.

SPEAKER_01 23:29

What else do you do?

SPEAKER_02 23:30

I right now, nothing. All I do is work, drive, sleep, work, go to classes, get my nails done.

SPEAKER_01 23:43

Okay, great. So Colina's saying that she has no life other than this podcast work and hanging out with me. Got it. So I'm so glad you asked, what do you do, Michael, to relieve your stress? Well, there's a few different things.

SPEAKER_02 23:55

I know what you do.

SPEAKER_01 23:56

Tell me.

SPEAKER_02 23:57

You take care of me.

SPEAKER_01 23:58

Oh, yeah, I do get really excited to see you.

SPEAKER_02 24:00

Last night when it was time for him to go to bed, I was getting up to brush my teeth, and I hear him go into bed and go, ah. And I go, Michael, why are you so stressed?

SPEAKER_01 24:11

So you said, Why are you huffing and puffing?

SPEAKER_02 24:13

Yeah, I go, Why are you huffing and puffing? He's like, I didn't know you heard that, but I just miss you already.

SPEAKER_01 24:19

I know. It's just like we have like this weird lavender like marriage situation. Yeah. Here's the deal. So I have always said I would never date in healthcare. Right? Recently being out and proud about being out of my like long relationship, I am definitely like more open to the idea of meeting people who work in the healthcare field.

SPEAKER_02 24:39

Let me ask you, why did you always say that you would never date in healthcare?

SPEAKER_01 24:45

Because I wanted separations between the hospital and personal life. One. Two. Can I say something? I argue, yeah, but I argue with doctors all the time. Or I used to when I worked at bedside. I no longer do that. But I was like, I don't want to come home and argue. There's something to argue. But I like to argue.

SPEAKER_02 25:02

Yeah, you're you are a fighter.

SPEAKER_01 25:04

Yeah. You love to argue. So I always thought I would never work with somebody who works or date somebody who works in healthcare, but I have like recently seen a couple people who work in healthcare, and I fucking hit it off with them. It's almost like you speak the same language to an extent. And I'm very aware of the fact like not every conversation is going to go healthcare because that's not healthy either. But I think it's about like finding a balance. And I think it's so funny that we're having these realizations with this show that is transpiring and going to be it's like that.

SPEAKER_02 25:43

Remember what I said earlier? Like, all I do is part of that.

SPEAKER_01 25:47

Is work.

SPEAKER_02 25:48

Okay.

SPEAKER_01 25:48

Thank you, Michael. So, but what is exciting is I've kind of had like this change of heart of maybe I am open to dating in healthcare. And I think that actually healthcare workers should date each other. Should date each other.

SPEAKER_02 26:02

As long I personally think as long as there is a mutual respect for what the other does. Because I do not want to date, I was having this conversation the other day in the break room. I do not want to date someone who is a nurse in the ICU.

SPEAKER_01 26:17

No.

SPEAKER_02 26:18

However, I would date anybody else.

SPEAKER_01 26:23

What about like anesthesia?

SPEAKER_02 26:25

Oh, 100%. Okay.

SPEAKER_01 26:27

Obviously. What about ortho?

SPEAKER_02 26:30

Yes. We have this conversation. We know. What about internal medicine? All dateable. Except internal medicine. Been there, done that.

SPEAKER_01 26:43

You know who you are.

SPEAKER_02 26:45

Um I I couldn't date someone who works in a clinic. I could not date a clinic doctor. Uh no, you're I'm talking um like a family clinic. Okay. Well, oh, like a uh urgent character. You're in like a surgical clinic. Like you there's surgery there.

SPEAKER_01 27:04

There's like so God, I just had a really good point and I just fucking lost it. Oh, dating. Okay. The best icebreaker is telling them what my job is.

SPEAKER_02 27:15

Oh, yeah. How do you explain that?

SPEAKER_01 27:18

Okay, so I don't know how I explained. Let's roleplay really quick.

SPEAKER_02 27:21

Okay.

SPEAKER_01 27:22

So I'm talking to you, whatever. Hey man.

SPEAKER_02 27:25

It's like so nice to meet you. You look better in person than like on your Instagram. I know. So, man, what's your job?

SPEAKER_01 27:38

You must be a model. Um, no, I actually work in aesthetics, specifically anal aesthetics. And then typically people's draws draw. Oh. And they're like, so what does that mean? And they're like, whole talks, and I said, Yeah, that has something to do with it. But I like go into explaining that I work for like a well-known.

SPEAKER_02 27:55

I thought we were role-playing.

SPEAKER_01 27:57

Oh. Yeah, so I work in this clinic.

SPEAKER_00 28:01

What type of clinic?

SPEAKER_01 28:03

An asshole clinic. I work for a well-known gay proctologist. I run the aesthetic department there. So I do anything ass related at this clinic. Can you show me some now? You want to see mine? Um, no, but it is a great ice cream because a lot of people have I mean, listen, it's like aesthetics. A lot of people think about getting Botox in their face, a lot of people don't. So I get 50-50 of like, oh, I've heard of like bleaching your asshole, or whole talks, right? Half of them are like, what the fuck does that even like have to do? No. Or a part of them have been like, oh my god, I know somebody who's been to your clinic, or oh my gosh, I've seen you online, which is fine. Um, but it is the best icebreaker. It's that, and I'm from Alaska.

SPEAKER_02 28:51

That is cool too.

SPEAKER_01 28:53

It's just like a very niche job to have.

SPEAKER_02 28:57

Wait, I'm mad.

SPEAKER_01 28:58

About what?

SPEAKER_02 28:59

Because I'm just a nurse from Connecticut.

SPEAKER_01 29:02

No, you're an ICU nurse who got her master's degree. You're hot as fuck.

SPEAKER_02 29:07

Okay, keep going.

SPEAKER_01 29:08

Um I can't say that thing anymore.

SPEAKER_02 29:11

Okay, never mind. Um no, but that is that is really cool.

SPEAKER_01 29:16

Great, thank you.

SPEAKER_02 29:17

And um, Michael, what are you doing for Halloween? Actually, I would love to talk about something.

SPEAKER_00 29:25

Okay.

SPEAKER_01 29:30

No, I wouldn't. You can't give me a mental stiffy. I'm gonna just take it away.

SPEAKER_02 29:36

I have this thing. Okay. Okay. I d I haven't done it at my current job, but as a traveler, I used to be like buddy buddies with people from different units to get what I wanted. Okay.

SPEAKER_01 29:49

Go on.

SPEAKER_02 29:50

And so I do this thing. I do this thing. It's called manipulation. Um, I do it all the time. And there are some times that In my current job, we have um emergency department residents that come in and out. Are they hot? And some, yeah, 100%. Because they're like on edge at all times. Like they're kind of rich.

SPEAKER_01 30:14

That they need like a release.

SPEAKER_02 30:16

Like they will pull a tube out just to put it back in, just because they need some action.

SPEAKER_01 30:21

Like, wait, that's kind of hot. That's kind of like a little bit of like med fet porn.

SPEAKER_02 30:25

No, they're they're like some of them are a little too much, though. They're like a little too excited. No, they're like, they're on like seven energy drinks and they're running around the unit and it's like time trying to relax.

SPEAKER_01 30:36

Your story. But oh fuck everyone. Classic Colleen forgot what she was saying, mid-story.

SPEAKER_02 30:47

However, wait, no, what was I talking about?

SPEAKER_01 30:52

Manipulation.

SPEAKER_02 30:54

So when they rap, like they they have like uh short man syndrome, is what I like to call it, even if they're not short, but they don't understand. So when a nurse texts you or epic chats you or says something to you and says, Hey, do you think this is how it goes? If they say, Hey, do you think we should do this? That's the nurse saying that is the nurse we need to order this, or saying this needs to be done, and I'm giving you the opportunity to do it, and to not make you look stupid as fuck, and I'm not gonna embarrass you in front of your friends or your attending, yes. However, there have been so many times where they don't get that point, and I think that every single med student should learn this because when they go into the hospital in their residency, yeah, we're not asking for no reason.

SPEAKER_01 31:46

No, if the nurse says, hey, hey, comma, the patient's sedation should go up to XYZ, or I went ahead and bumped the patient's sedation. Remember when you wrote that order?

SPEAKER_02 32:02

Or, or you say, Hey, this is happening, this is happening. Do you want me to do this? And you do not agree with me. That means I've seen this before, I've done this before, and the answer is yes, thank you so much. Not even a thank you, I don't need a thank you. Yes, you do it, okay.

SPEAKER_01 32:23

Put in the fucking order.

SPEAKER_02 32:25

That's a fact.

SPEAKER_01 32:26

Just put it in.

SPEAKER_02 32:28

So I've learned this whole manipulation thing from a a small girl.

SPEAKER_01 32:35

So what do you do? Stroke their ego?

SPEAKER_02 32:38

Yeah, to get what you want sometimes, yeah. It depends on the person. I have personally found there are two groups, and one group of people will come up to you and say, yo, I have never seen this. What do I do? Like I've been in an emergency where the and she was a very high-up resident. She was like the chief resident at the time, and she was like, What do I do? And I will say, I don't know. If I don't know, I'm not gonna pretend I know. Yeah, no, absolutely. And and no nurse will pretend they know if they don't know because there's no point.

SPEAKER_01 33:12

I agree, but if the nurse knows they're gonna push me, yeah, yeah.

SPEAKER_02 33:16

And I'll say, I'll go find a nurse who has done this, who has seen this, who might know.

SPEAKER_01 33:20

Something brilliant brilliant about humility, especially in healthcare.

SPEAKER_02 33:24

But then there's others where they simply will not, like the other day. Not the other day, uh a while ago. It was the other day, but I'm not gonna call them out. You know, simple thing, okay? Potassium is 3.6, which is okay. Fine. Now we give the patient LASIKs twice throughout the day. Potassium's in the shitter. Dump out. It is a simple task that I'm not expecting a doctor to have on the top of their head. Correct. There's other things for them to do, which is fine. But when I say, hey, the potassium was 3.6, I gave 120 milligrams of LASIK. The patient has put out three liters in the past three hours.

SPEAKER_01 34:11

Let's replace some potassium and draw a BMP.

SPEAKER_02 34:14

And they say, no, I don't think it's appropriate right now. And I say, I'm not asking you. I'm telling you.

SPEAKER_01 34:24

So put in the order, or I'll put it in myself. And that's what did the potassium come back at?

SPEAKER_02 34:30

It was like 2.9 or something.

SPEAKER_01 34:33

Yeah.

SPEAKER_02 34:33

Because they're like through they have like ectopia everywhere. And I'm like, okay, they also have ectopia, like their heart rate is, you know, they're in their biggeminy or whatever. I'm like, oh, really? I wonder why. Because the potassium is now on the floor.

SPEAKER_01 34:50

Or it's like when we were talking about not giving calcium with um hyperkalemia protocol. Yes. Hyperkalemia, high potassium, high potassium or low potassium is very, it can be very fatal. It can be fatal. Uh affects the heart. Hyperkalemia, so hyper high um potassium levels. You reflect you essentially can bring it down by giving IV dextrose with insulin. With insulin and IV calcium gluconate.

SPEAKER_02 35:26

But you people forget this is an educational moment. We're being very nursey.

SPEAKER_01 35:30

Yeah, I know.

SPEAKER_02 35:31

You give the calcium first to protect the heart. Because the heart can go into a crazy like rhythm. And it and it does. It nine times out of ten, if your potassium is really high, you do have not nine times out of ten, I'm not sure, but you always give calcium first to protect the heart. That's the most important. Then you give the insulin, which pulls it, pulls the potassium into like the extra space or whatever. You give the dextrose so that you don't die. And then but people forget about the calcium.

SPEAKER_01 36:02

Which then can affect their heart. Well, I feel like this has been a very medical heavy episode of Scrubs off bottoms up. So anywhere from eat your bananas to play with your asshole, I think it's been an educational session for us.

SPEAKER_03 36:20

Sure.

SPEAKER_01 36:21

Yeah, we love it. Alright, folks, with that being said, this girl's tired, she cannot finish a thought, and she needs to go meet a friend. You with that being said, scrubs off. Bottoms up, baby. Cheers, babes.