Monday, June 28, 2010

The Dry Season

I wish it were simply a seasonal variance, the emergency department's environment of dry, humid-less air. A fifth season, of sorts, that would arrive between the last snowfall and the first flowers of spring. We could prepare, in advance, for the pruning process of our bodies, expecting and accepting every minuscule of body hydration to escape us during this period. Then, after a month or two of tolerating mosaic-like skin, we could move on to the next season.

Unfortunately, though, the ER's dry climate is a year-long season. The temperature-controlled, recirculated, skin-cracking air seems to be an everyday affliction. One that most of us have learned to deal with in our own little ways.

The answer could simply be to drink a lot of water. Which isn't easy, since free-time is a luxury in the ER. Remembering to take a drink is usually not a prominent thought during a crazy shift. Maybe the answer is lots of lubrication. Some people need to apply, and reapply, multiple applications of skin and hand lotions before and during a shift. A tube of moisturizing lippage never seems to be far from the typical ER employee. Despite all of these efforts, though, sometimes you simply can't outrun the gusts of stale ER air.

You will crack, my friend, you will crack.

How do I approach this problem? Probably much like most of my co-workers. I try my best to drink a lot of fluids, whether it is plain ice water or with a packet of flavoring mixed in. In the ER, though, sometimes it's just too hard to keep up. At times, even, I have completely forgotten to drink something until I urinate, for the first time, ten hours into my twelve hour shift, and notice my concentrated Sahara urine. Occasionally, we don't have our usual supply of water pitchers to make it easy for us to run to the ice and water machine. During these times, as I learned during residency, I resort to using a clean male urinal bottle to hold my iced water or, better yet, my urine-resembling iced tea. I've made a few people jump (freak-out, actually) from that move. But, hey, at least I am hydrating myself, right?

I also use my Aveeno lotion and my Burt's Beeswax lip balm faithfully and, still, I get dry skin and cracked lips. I have switched brand names to no avail. I have become intimately familiar with every option of every brand of moisturizer in our local pharmacy. I use nasal saline mist spray. And still, I crack. On a side note, I even tried slathering myself with Neutrogena body oil in the shower after I was done washing. Trust me, I didn't like that feeling of being all slicked-up, like a greased pig, for the rest of the day.

It is what it is, I guess, and comes with the territory of our jobs, being cracked and dry and parched. Two-bit impostors of some scaly crocodiles.

Which leads me to today's story.

Recently, while we were out, several of us were sharing some of our more embarrassing work stories with one another. I have enough of these stories to fill a book, actually (do me a favor and act surprised here), and will humbly share several of these stories along this blog's journey. Nothing makes me happier than when we can share and laugh at ourselves, embracing the fact that we too are human. Humble, modest humans. Self-deprecating and all.

Anyway, after the mention of the dry ER climate ("What the heck is up with that?" "Why can't they get a humidifier attached to the furnace?" and "Who gets cotton mouth at work?"), I decided to spill the beans of a time when I was in residency in upstate New York.

I was in my last year and had just finished a grueling twelve-hour shift, working from 8 p.m. to 8 a.m. It was one of those nights where the morning couldn't come quick enough. Lots of traumas, lots of cardiacs, lots of sickness. And lots of coffee. I don't think I had eaten or gone the bathroom the entire shift. It was one of those shifts you leave thinking that "Yeah, I got my ass kicked, but maybe, just maybe, I did make a difference during this one."

At eight, we gathered with the incoming team to sign-out our active patients. I was so dry, cotton-mouth and all, that I could hardly give my report without breaking every five seconds to lick my lips and try to swallow. After report, I went to our locker room and chugged five minutes from the bathroom faucet. Lucky I didn't catch anything. I applied my Chapstick and was on my way.

The drive home consisted of me taking two major highways, about five minutes on each, before exiting onto a country road and finishing the peaceful thirty minute drive. As I started out on the first major highway, I glanced at myself in the rearview mirror and noticed the big bags under my eyes. And then I gasped. Right there, dangling from my nose, was a cruddy, dried-out booger.

Or maybe it was the crumb-topping from a piece of apple pie. Oh, that's right, I didn't have a piece of apple pie with crumb-topping.

Well, I was mortified. Was that dangler there during sign-out? Or had it just been born minutes before while I was changing out of my scrubs? I felt like I should have given it a name.

Well, of course I couldn't let it just sit there. I had to get rid of it. Not an extra-napkin carrying kind of guy, I knew I wouldn't have any tissue in the car. So I just knocked it off, onto my car's floor. But did I stop there? Noooooo, not moi. I had to make sure there weren't any more. So, unfortunately, I did a very slight, superficial dig. Or maybe it was a quick side-swipe.

And that's when I got busted. As I was scratching and not picking, looking in my rearview mirror, I suddenly heard some relentless horn-honking. I looked to my left, out of my driver's window, and there were three college kids passing me in the left lane, all pointing at me and mimicking picking their nose. They were laughing quite hard, I must admit. And who could blame them? I would be, too, if I were passing a nose-picker in another car and was with two college buddies.

Well, of course, I had to laugh along, but not until after I cursed the dry ER. If only I had one of those misting fans attached to my neck ID tag, this might not have happened. And to add insult to injury, the back seat kid mooned me as they sped by. Can you believe that? The bastard! I'm okay with getting mocked, but I didn't like an unknown bare-ass giving me an 8:30 a.m. wake-up call.

I turned off the major highway onto the next one and, surprised not to have any cars in either lane, finished the swipe job. Took a big drink of my bottled water. Applied my chapstick. Laughed at myself. And hurried home to the welcoming arms of my wife, she who married a booger picker...

I don't think so.

And all because of the eternal ER dry season.

As always, huge thanks for reading. I hope you all had a great weekend. See you Wednesday, June 30...


Laanykidsmom said...

1) I love Burt's Bees. It's the only chapstick I use.
2) After working to save lives for 12 hours, you can pick your nose for as long as you want. I daresay those college kids were partying for the past 12 hours and not contributing to society like you were!

Rachael said...

My skin has always been so dry that it occasionally bleeds. I gave up on it years ago. My toddler has the same problem, and his dermatologist recommended Curel continuous comfort. I have started using it too. For the first time in years, my skin feels moisturized. Give it a try if you haven't already :) (and no, I don't work for curel - but it sure sounds like it, huh?)

Empress Bee (of the High Sea) said...

yeah, like those kids never did that! right! little buggers...

smiles, bee

Stephany said...

Being in the ER for up to 12-15 hours with my daughter several times, I know the dehydrating effect those places have! No water for patients or visitors waiting, I always politely asked nurses for water PLEASE. It's like the Sahara desert. Now I know it wasn't just me!

Burt's Bees for lips

and try for hands work the best for ppl who have to constantly wash hands/have wet hands such as nurses, doctors, hairdressers, teachers.

I worked as a volunteer art docent in the elementary school one year. I helped them create their own paper. From dry paper to pulp, scent was added and some powdered substance, can't remember what it was now---but after the project was done, school was over for the day, I walked through the halls in front of kids, parents, people who knew me, drove home only to look in the mirror to see a nose with 2 nostrils full of pure white, what appeared to now look like i have inhaled plaster of paris, including a nice dusting over the eyebrows.

No one said a word, thank goodness I didn't go to the grocery store before home.

Katie said...

We must have been on the same brain-wave yesterday. My complaint about dry skin didn't make it past the first edit, though. I might be able to give your dry skin a run for your money. Every winter I have a tendency to look down and realize the back of my hands are bleeding even though my purple Nalgene is practically surgically attached to my hand and I've always got some lotion handy. I've found Aveeda to be great for my hands. It's a bit pricey, but it's the only thing that works. I use Aveeno for my face and that's been nice as well.

By the way, there's something in you nose.

<>< Katie

WarmSocks said...

VBG-Worse things could happen than having some strangers notice that you didn't have a tissue handy.

You probably don't want your comments section filled up with home remedies for dry skin, so I'll refrain from writing a book here. Good luck!

Karen said...

If you had recounted another story of a double crack along with this, it might just be your best post ever! :P

Anonymous said...

Great story, Jim. Got me grinning. And I'm sure we could ALL tell tons of embarrassing stories, given some incentive. Though I can't think of anything ... ;)

Cal said...

I have cracked lips year-round if I skip the lip-balm. Burts Bee is good, the best at hydrating your lips I have tried is the hemp one from the Bodyshop, but it tastes terrible, so don't get it.
Boogers... how to tell people they have one hanging? Hard job, but we all wish someone would tell us!

NurseExec said...

This one made me smile :) When I lived out west, this was a constant problem. Not so much down here in the land of humidity hell (FL). Have a great day!

Anonymous said...

Lanolin. Apply to hands. Remove excess with paper towel. Wash hands. A coating of lanolin remains. Dry hands with paper towels to avoid lanolining your nice towels. Have slightly sticky hands for 10 minutes. Problem solved.

For lips just put the lanolin straight on.

Christine said...

Can't believe that no one told you that you had a bat in the cave during report.... That's so wrong.

SeaSpray said...

It's easy to forget to drink when too busy. But another reason I intentionally didn't drink for a good part of an 8 hr shift on hellacious nights is there would be no time to go to the bathroom with out backing things up.

But two words ..*KIDNEY STONES*!

That event has forever changed my camel ways... unless ..I forget because too busy.

The urinal was a great idea! I got a bottle from my urodoc that I think held 72 or 76 oz of water. It was great because it gave me a good visual for keeping track of my fluid intake for the day. And caffeinated drinks will dehydrate one even more. So you do need to replenish with other beverages.

I've heard that licking your lips will cause them to dry out more but don't know if that is true.

Wearing lipstick and lip gloss helps keep lips soft. Uh ..but that won't work for you.

I do NOT understand why people don't tell others they have broccoli in their teeth, their fly is open, the bat cave thing, or tissues stuck all over their face.

i guarantee I will tell you because gosh ..I'd be grateful if someone warned me! Ha! One hot day while working in Patient Access ..even tho the a/c was on ..I was sweating. I blotted my face with hospital issue tissues. Issue tissue. :) Anyway, I registered 3 patients and then went in back of ED for a break. I was sipping a cup of coffee, talking with the ED doc for about 5 minutes before he FINALLY said .."You Know have little pieces of tissues stuck all over your face.?"

Mortified ..I jumped up to look in the mirror in the bathroom across from the break room. MULTIPLE tiny pieces of tissue were indeed stuck all over my face. Stupid cheap hospital issue tissues! What were they thinking ..that they wouldn't tell me? I guess people just don't want to be in the awkward moment.

But he was also a surgeon and I've read that surgeons are so tough ..they'll eat their young in residency... but he took 5 minutes to tell me? At least he did and it was funny.

Thankfully no one mooned me. ;)

Funny story Jim. Thanks for sharing it... and for being real.

Have Myelin? said...

Let's see. Would I rather see kids mooning me or a man picking a nose? Yep, the man picking a nose. LOL.

Anonymous said...

The tips of my fingers and heels sometimes crack and bleed in the winter. What makes them feel better is to before bed slather on an emollient -- could be something as simple as petroleum jelly -- followed by an occlusive dressing like plastic or vinyl gloves for the hands and a plastic bag covered with a sock for the feet. By morning the skin is much softer and less painful. The most important thing is not the brand of emollient used but rather the occlusive dressing over it worn overnight.

Maha said...

If I ever quit my job, the contents of my locker would be enough to open a mini bath&body works shop. I now moisturize religiously and I even mix my own concoctions. I'll try Burt's bees next because the clinique stuff is getting expensive! Great post as always. Looking forward to the next one :)

Meghan said...

My roomie and I in college used to work in the cafeteria. One day, we were in charge of making all the jello. You make it in huge buckets, and every time you went to run water over the dry powder, a whole bunch would puff in your face. So I got home that evening to discover that not only did I have a "bat in the cave," but that it was, to my horror, (and secret delight), bright pink. (from the red jello powder). Blue jello day was entertaining too :)

Heather said...

Cerave lotion---comes in a big pot (Walgreens/CVS)...non-greasy, easy to keep within reach.

One time I went through an entire shift without ever going to the bathroom.

When I got home, I was sure I was dying of a kidney infection.

I wasn't. I just had to go really, really bad! ;)

tracy said...

Christine "A bat in the cave"...that's one i've n e v e r heard and i love it! Thanks! :)

Annnnnnd, thank you, Dr. Jim for a great, story...sorry this happened to you, however, it does make a great, if self-depreciating, tale. ;)

Anonymous said...

I thought you were going to mention nose picking...and...if you believe in Darwinian theory, or even think it could be true that we come from chimps, it's only natural to recognize that the nose has done it's job to collect things, and so following this, it is our job to prevent the gobs from flowing down our throats.

Pick your nose and eat it is another discussion that I hope would only appear on "The Survivor" blog, or whatever...

Anna said...

Jim you are too funny, lol. I do to have those moments too, and like talking about them too, and many times laugh at myself. Now, about the dry skin. May be try taking cold showers, or washing with cooler water too. The hot water opens the pores, and the more you open them the natural body oils get released, and you definitely need those. Not sure if it is hundred percent true. Anna :)

Anonymous said...

I second Heather with regard to Cerave - it's the only non-Rx skin cream that is reasonably priced and contains ceramide to rebuild your skin's barrier layer. After showering, apply moisturizing cream/lotion all over and allow to air dry. My allergist at National Jewish suggested this when I lived in Denver. (He also recommended Vanicream, which I found awful - Cetaphil was more to my liking until I discovered Cerave.) If this is not practical due to humidity, DHC's Q10 Body Gel ( works well when used this way. The best hand lotion I've ever used is Atrix (aka Atrixo). It contains a lot of glycerin, absorbs quickly, doesn't leave your hands greasy or sticky, and holds up well through multiple handwashings. Sadly, it's not sold in the US, so I stock up when in Canada, Mexico, or Japan. Perhaps you could get it through Rakuten Ichiba (which has an English website) or someplace in Canada.

(Disclaimer: I do not work for any company that makes any of the products mentioned, nor do I sell them; I'm just a satisfied user with very dry skin.)

Stacey said...

Since everyone is giving recommendations here ;)

The two I prefer for work are Lubriderm or Johnsons Baby Lotion. The original kinds, not anything fancy or added. They're not the most moisture you can get, but I fill a travel tube with those and put it in my pocket at work. It's great moisture, handy to have around all the time, and not so thick and sticky that you can't immediately snap on a pair of gloves again.
For after work, something with more oils and shea butter and cocoa butter is nice.

-Contents of my scrub pockets: ink pen, hand sanitizer, gloves, lotion, chapstick, gum or hard candies (also great for the cotton mouth)

I always tell people when they have a booger (or eye crusties or anything else). Then I find sesame seeds in my front teeth 2 hours into the shift the other night (rounds, report, a minute to chat..lots of people)...why has nobody told me this?!

Caro said...

Duuude :P

10% super-greasy carbamide lotion! Take it from someone with atopic eczema who works in a pharmacy that suffers from this drought all year round :P (I'm sure the meds like the dry climate, but our noses, lips, and eyes do not :P)