Sunday, September 28, 2008


As an aspiring author, my work is often critiqued as being too detailed. I am told that I need to keep it short and sweet, giving only as much information as the reader can handle. Okay, I can see that. We don't want to bog the story down unnecessarily. But if you're too scant on the detail, the reader ends up confused, and puts the book down in frustration. Me, I err on the side of abundance.

Perhaps it's a knee-jerk reaction to work. I spend a lot of time writing a lot of things as briefly as is humanly possible. For example:

'9/26/08 1830 Nsg. Report rec'd, assumed care of pt. Assessment per flowsheet/path plan. VSS, afebrile. Pt NPO 2400 for LHC in AM. SR on monitor. BP, HR WNL. Will cont. to monitor pt.
2030 Pt c/o CP. CP protocal init. EKG shows no changes. Pain relv'd nitro tab x 2. Physician updated, orders rec'd and noted.
9/27/08 0130 Pt c/o CP. See flowsheet/code sheet. Physican notified, orders rec'd. Vent settings: PRVC 16, TV 450, Peep 5, FiO2 100%. Pt to OR.
0430 Pt back from OR. Vent settings unchanged. MT & PL CTs to LWS. Pacer wires taped. VSS, afebrile. SR on monitor. BP, HR WNL. Assessment per flowsheet/pathplan. Will cont to monitor pt.'

Now, from this, can you tell what happened?

Here's the translation. 6:30 pm. The patient is fine, and going for a cardiac catheterization in the morning. Because of that, he can't eat or drink after midnight. At 8:30 pm, the patient had chest pain, which was relieved by two nitroglycerin tabs. The EKG was fine, the doctor was updated, gave a few orders, which were done.
At 1:30 in the morning, the patient went into cardiac arrest, was given CPR, drugs, and several shocks. He was also sedated, intubated and placed on a ventilator. Since he was already in the ICU, he wasn't transferred, but the Cardiothoracic surgeon came in (yes, at 2 am) and took the patient to surgery for emergency bypass surgery. (guess the cath got cancelled).
Patient came back at 4:30 in the morning, with chest tubes hooked up to suction, pacing wires attached to his heart, and many other new wires and tubes. And yet, stable once more, by nursing standards for a fresh post-op open heart patient.

Is it any wonder I rebel and give the detail?

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