Bite Me

It is absolutely essential that I have a laugh at work. For that matter, I pretty much have to laugh wherever I go. I have been called witty, but when I'm together with my brothers the zingers fly. It is nice that my two adult children have the confidence to step into that arena now. They are both VERY funny; my son J is dry as a bone. K, my daughter also has a great sense of humor. We do laugh a lot together.

The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.


I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...

Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice

"Nope. Just the head", I kidded. "Wanna know his name"?

"Ok, what is the dog's name" she said, bracing for impact.

"John the Baptist".

Ouch.

Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".

My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.

The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.

Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.


One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.

Are you kidding?

"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"

We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".


Oh, of course I completely understand now.

I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.

Speaking of biting critters, one of my co-workers, Sherry, goes to Alaska every summer to canoe down random wilderness rivers above the arctic circle. She and her husband are gone weeks at a time. They eat a lot of jerky and soup because they neither fish nor hunt; they are very concerned about their carbon footprint. Sherry and hubby have done these trips for years, loving peace and solitude, the beauty of their surroundings and usuallythe abundance of wildlife.

They have never had the kind of chilling close encounters with grizzly bears they experienced this year. Apparently there was some kind of grizzly bear convention because this year, not only were the bears present in unprecidented numbers but they were very curious; one might even say they were stalking my friends. This went on for days; they would make camp and bears would always be nearby. One even started running her way, far enough but still too close for comfort. Apparently, because they were without any kind of weapon except Grizzly Bear Spray in a can for REALLY close encounters, they largely deterred these creatures with a whistle or shouts. I wouldn't have closed my eyes. Ever.

"How can you go into the wilderness without a gun?" I asked.

Sherry was so completely unnerved by the memory of charging grizzlies that she told her husband that she didn't think she could do the trip next summer. Her husband thought it would be a good idea if they brought a gun next year because he really wants Sherry to go and feel comfortable. He even said he would learn how to shoott.

"Well, you need to learn too!", I exclaimed.

"Oh, I grew up around guns. My Dad still hunts. I know how to shoot", she replied. Yikes. Apparently her husband is the pacifist, and was begining to see the danger inherent in this situation in a new light.

I thought that as the weeks and months went by Sherry and her husband would take a more assertive approach to procuring a firearm. Unfortunately, the epiphany was short lived and her husband is backing off and losing his resolve. Sherry, on the other hand, just bought a can of pepper spray, which you don't need a permit to carry in this Shoot Pepper Spray and Live Free or Die state. Today pepper spray, tomorrow protection against grizzlies.

Good luck Sherry! Guess your husband will simply have to continue to use harsh language voicing his extreme displeasure in unequivocal terms while taking care not to damage the self esteem of the native ursus arctos horibilis.

Read to the bottom for full hilarious effect. Love it!

The Patient is the One With the Disease

The lady who rushed into the ER last night after having her forearm punctured by her cat's sharp little teeth was in the department again less than 24 hours later when I got to work. She had gotten her wish: because she neglected to take the proferred antibiotic for 15 hours she developed the cellulitis that she insisted she was going to get. This was fairly predictable since she pretty much wanted to be admitted last night when she came in. When there was no redness or swelling. She wanted to be admitted prohylactically. I don't know about you, but such individuals just creep me out. There is an alarmng population of individuals who revel in their illness, delight in their disability and can't wait for complications. It is all about the attention, either from health care workers or family and friends.

Lots of people will fake pain so they can get narcotics; some are addicted, some sell them to get other drugs. The majority of these adopt a "pitch 'til you win" strategy. They make the rounds of every ER until they get what they want. Since we close at 11 PM, unless we have patients in the department, many have figured out that if they come in at 10:50 PM we will be more likely to give them the Vicodin or Percocet. Sometimes it backfires. One of the docs will only give Tramadol, which is fairly useless to the hard-core narcotic seekers. Let me assure you, though, we do evaluate everyone individually for their pain issues; sometimes we actually get someone who has 1) legitimate pain, which we 2) relieve

Still, some people have some pretty elaborate stories; it goes like this:

"So I've had this pain in my tooth for about 2 weeks, tylenol doesn't work, aspirin doesn't work, ibuprofen doesn't work (fill in time of last over the counter pain med administration, usually sometime yesterday). I have an appointment with the dentist next (fill in the day and date) because I had to reschedule from (fill in the last 6 dates for alleged cancelled appointments). The pain is really bad, it goes into my jaw and into my neck. It's 10 out of 10, I can't eat or sleep. I had some Percocet but i finished them. Does my face look swollen? It feels swollen. If I could get some more Percocet to tide me over until I see the dentist that would be great. Did I mention my pain is 10 out of 10? It's really bad No, I didn't call the dentist to see if I could get an earilier appointment"

Because I have many years of experience and generally know how to synopsize most complaints, my triage not says simply:


"Dental pain. Requests Percocet"


That about covers dental pain. It makes me lose interest really quickly, especially when we've seen the patient 5 times in the last 3 weeks, and it's always the same story. Many times the patient will get a 'script for Vicodin AND Penicillin. Guess which 'script never gets filled?

My favorite doc is keenly interested in relieving dental pain; he will do an injection of local anesthetic just like the dentist does. Not all of them do this, but I think for the legitimate dental paineurs it is a great option to buy them some time to get to the store for one of those temporary filling kits. Alas, some people refuse this option as you can imagine.

Not all the docs have the training to do this, which is why I think my friend Debbie, who teaches this skill to hygienists and dentists, should come up and do a training session. She could clean up $$ wise. Must remember to talk to her about it, several of the docs were very interested. It sort of seperates the wheat from the chaff if you get my drift.

Today's Last Patient of the Night

From time to time I will try to keep you amused with stories about our final patient before we close. Last night we had the young man whose chief complaint was:

"I went to the bathroom and there was a bug"



The young man stated that he got really drunk and had a one night stand. He was so drunk, he said, that he couldn't even remember when it happened. Having casual, unprotected sex while intoxicated gave him a nice souvenir of the occasion. Even if he couldn't remember it. Or the woman. In fact, it gave him several hundred souvenirs.



He was in his 20's, and he was: With. His. Mother. She sat right there in triage and kept saying disgustedly "I can't believe you got drunk and caught critters"



Really. All things considered, I can't believe he actually had sex.



I never want to examine these type of complaints too carefully because the little buggers can jump; I leave that to our highly paid board certified emergency physicians. Besides, I would have had to put on my glasses and really PEER intently at his crotch. Frankly, I don't get paid enough to do that.



He went on his merry way with his prescription for Kwell with Mom still berating him. I felt kind of bad for him cause he was a little clueless. Still can't believe he had sex.

The Games Have Begun

Hey! Anybody still there?

Summer was gone in a flash; why is that? It seems like just yesterday I took a day trip to the lake with Tina, enjoying a nice warm day, some kayaking and a cold beer or two. Ahh, the good old days.

I found this photo in my camera; David, are you noticing?

My brother and I used to have a

competition to see who could get the best sunset photo. Even though he is a better photographer than I am, this is clearly a contender. I would have liked to get up to the lake one more time for some leaf peeping, but it didn't happen. Too bad. I did get up there last year in October with two friends from nursing school. The temp went down to the mid-30's at night; we had not heat and no water, but we had a great time and some nice views.

Fall always makes me feel like taking a big, deep breath and square my shoulders in preparation for the onslaught of the winter edition of the Sick and the Stupid. Mostly because the sick stay home while the stupid go to the ER. Somehow doesn't seem right,now, does it? This winter flu season is already off to a rip-roaring start and promises even more New! and Improved! Sicker and More Stupid! individuals crusading to the ER in search of the Holy Grail.............instant gratification!

Now, we are staring down the barrel of winter; the kayak is in the barn and I barely come up for air since I am ALWAYS studying. Micro blows, thanks for asking.

We have had lots and lots and lots of individuals present with flu-like symptoms, it is a cornucopia of influenza We have given up mining for flu and just treat them for it anyway, but in most cases there is nothing to really go mining anyhow. Cough, no fever. Fever and vomiting, no cough. Sore throat. Many are simply diagnosed with viral illness, better kept at home with
Tylenol, rest and fluids. Somehow, though, these folks who drag themselves to the ER because they are so sick hear the word "virus" and take it as an open invitation to go to work. Or to send their kids to school so they can go to work.

Please, people. If you are coughing relentlessly you may as well stay home; your co-workers don't appreciate your attendance. Seriously. Nor do other parents appreciate having your ill children in school. Giving them Tylenol, sticking them on the bus and boogeying off to your oh-so-important job is not only so awful for your kids it makes you look like a complete jerk; kids ALWAYS rat you out to either the teacher or the school nurse that mommy gave them Tylenol for their temperature. Always. Having been a school nurse and knowing this trick I always asked the kids; usually they knew how high their fever is when they left home. I made it a point to convey this information to the parents when I called them.

Yeah, I know. Everybody is talking about the flu, or blogging about it. Or talking about blogging about it. Let me tell you, it is only going to get worse before it gets better. I will try really hard not to roll my eyes relentlessly because my mom told me they would stick that way.

People are panicked about the H1N1. "Last year", I complained to Dr. Cindy Lou, "this was just the flu. This year it is the Four Horsemen of the Apocalypse. And we haven't even started to see a lot of REALLY sick people. The doctor's offices are dumping all their patients here, and I'm sure it is going on all over. What's going to happen when we all get sick?".

And we will, we will. Some of our patient population is, to put it mildly, a bit challenged with the social graces. In other words, coughs and sneezes are not covered, but left to fly freely throughout the atmosphere; I have seen someone place USED KLEENEX on the registration desk; hand sanitizer? what is that? And the kids? don't get me started.

One of our unit secretaries Melissa, is pregnant with twins; around 22 weeks. When patients come in to our ER, she is one of the first to greet them. In other words, she is flu fodder. Being pregnant, she is, along with children, one of the high risk populations. She is nervous because her OB does not yet have the H1N1 to distribute until this week.

"Melissa, don't even talk to them unless they are wearing a mask!", I told her. "Just back up and point to the triage area, yell to one of us (nurses) and we'll take care of it. No sense putting yourself in the line of fire unnecessarily"

That is when I had the bright idea to create The Altar.

A little table containing a few face masks...............no, not this one.

more like this.

I added a big bottle of hand sanitizer and a sign that read:

IF YOU HAVE

COUGH, FEVER

OR

FLU-LIKE ILLNESS

PLEASE WEAR A MASK

TO PREVENT THE

SPREAD OF INFECTION

The "thank you" got cut off of my document. My boss thought that it was great that I was showing some initiative for "projects" (calm down, it won't happen again until after I finish with this synchro season, graduate from school and go to Alaska....in other words, don't hold your breath). Melissa was thrilled, and very relieved. And for the most part, people are pretty good about taking the masks. Of course some need to be educated about: the need to wear the mask over the nose AND mouth; that they are ineffective in the pocket or on the head when worn as a hat; and for Pete's sake, please leave some for the contagious people who are coming in after you, just because it's in a little basket doesn't mean it's appropriate for you to take a handful. Yikes.

Oh crap, I just remembered today was my brother Bob's birthday. HAPPY BIRTHDAY, BOB!

Donorcycles and Near Drowning

Spring never came, summer looked as if it might skip New England entirely and it has been raining for a month. At last, the sun is out and warm weather, it seems, has finally stuck the landing here in the Artic Tundra of the northeast. Every SUV has a dog's head sticking out of it, mine included. Tina, my dog, is happily chasing chipmunks in the woods. Yesterday, I'm not lying, there were two ducks sitting in a tree in my backyard bog. That was a first for me, so I had to Google "Do ducks perch in trees" just for laughs....guess I'm not the only one to wonder since there was quite an extensive amount of informtion to be had on ducks perching in trees. Mr. EDnurseasauras was not best pleased to be awakened to see this once in a lifetime sight, though. Oh, and the grass is green and my eyes are watering. Other sure signs of warm weather are yard sale signs; I saw a sign on a tree in one neighborhood advertising "Puppy's For Sale". Puppy's what? Being a stickler for spelling and grammar, that really annoyed me. The hot dog stand in town advertised with this hastily written sign, in magic marker on a poster board:

"Hot Dog $1.50 withacanofcoke" kind of squished in. Hurryupandeat.

Being the first actually really hot day means that all the pale skin that hasn't seen the light of day since Labor Day is going to get roasted. Pass the melanoma please.

Bikes, skateboards and other devices invented for challenging the fragility of the human body are being dusted off so that we who work in the ER have job security. We have lots of sutures and tetanus, and have stockpiled slings, casting material, splints, bandages and crutches.

And the sure sign of spring: motorcycles are back on the road for all of the seasonal drivers (Simplysweet, I'm talking 'bout chu...). Indeed, they are everywhere. In this Live Free and Die Stupid state, the mandatory use of helmets is not a law...more of a suggestion, actually. Of course, those of us who care for such idiots who choose not to wear protective headgear and wind up in my ER could tell you a few stories about ruined bodies, ruined lives and ruined families. Here's a small public service announcement for anyone who doesn't wear a brain bucket; some may believe it is just another means of thinning the herd, but scraping your brains off the highways and byways is someone's job. I guarantee it does not make anyone's day. Let me walk you through a couple of scenarios.

Patient A is traveling along the road on a bright sunny afternoon on his Harley, wearing jeans, a T shirt, and sneakers; he is not wearing a helmet. At a speed of 40 MPH, for whatever reason, he hits a patch of dirt, a rock in the road, swerves to avoid a squirrel and loses control of the bike. He is brought to the ER unconcious with a big bleed in his head. This turns out to be a really bad day for him because, despite our best efforts, he dies of his injuries.

Patient B, while riding his Harley on a lovely summer day also hits a patch of dirt, swerves to avoid a squirrel and loses control of his bike. He is brought to our ER concious and alert, but with a big crack in his helmet. That helmet saved his life. I don't know anyone who has sustained an injury without a helmet and survived who persists in riding without one. I am sure they are out there, though.

Another equally stupid idea is to let kids ride those ATV's. I don't know the law on this but it just doesn't seem to make sense to let a kid behind the wheel of something so heavy that he would be powerless to get it off if landed on him..........provided he was still alive. When you bring in your 9 year old covered in blood from an ATV crash telling me he has been riding since he was 4 merely signals me that you are an idiot and should be locked up.

Two separate but related incidents tended to bring out the sighing, eye rolling and lecturing old nurse in me.

We heard the radio call from MAC base on our scanner about a 3 year old who had fallen in the river not far from our facility

"We won't get that, will we?" asked Cathy, my Southern Girl coworker.

"Maybe. If the patient needs an airway we will, it he's coding we will, and if it was more of a swim than an actual near-drowing we will". I get out the warming blanket just in case.

Sure enough 20 minutes later we get the patient, a little cold (the river is frigid this time of year) and his mother who went in after him. His head went under for seconds before she brought him out spluttering and crying. An eyewitness said she was reading a magazine when the kid went in. So it turned out lucky, and thus the weak members of civilized societies propagate their kind. This was reinforced after I met the dad.

He appeared to be a combination of Colonel Sanders and Mark Twain, complete with beard and straw hat to go with his portly appearance. He had no trouble telling his kid, loudly, about all of his experiences in the ER.

("This one time, at band camp...")

Seriously dude, I do not care if you had a broken toe or a bee sting. Neither does your kid, and where were you when your wife was reading a magazine while your son decided to go for a swim in the Swift River? I really just hate in when people act like a parent for my benefit. I already know you're an idiot, just shut the hell up. Sheesh.

Two weeks later, in rush the Parents of the Year with the little swimmer. "I think he cut his finger off!", Mom shrieked. Dad, affable as ever helped the situation not one bit by trying to tell the kid how he cut his finger when he was 5; all while we are trying to get information about how the injury happened, etc.

The child was playing with a disposable razor. Yes. A. Disposable. Razor. The excuses this time included, "well, the cap was on, and he's played with them before. He likes to pretend he's shaving".

Oh, that's different. Perhaps you'd like to give him a knife to stick into an electrical outlet when he gets home? It should be OK if the knife has a wooden handle. Pour a little water on the floor too. And hey, instead of a sticker, please let him help himself to a fun Bic lighter; we have an array of colors to choose from.

Yikes. The finger wasn't cut off, only needed a few stitches. Ever helpful, Dad retained the focus on himself the entire time, not getting the hint when I suggested he could maybe talk to his son to keep him calm. Finally I had to say "Dude, pay attention to your kid, please! This isn't the time to share your diarrhea problem with the class!". Idiot.

Discharge instructions included (no lie) "Do not allow child to play with razors", and "Choose appropriate toys". Oh and expect a visit from social services at some point.