Sunday, February 12, 2017

Winter is coming

We are deep in the bowels of winter, cold, stormy, piles of snow, no sunshine.  No place to walk.  No place to park the car at work.

And sick folk.  Soooooooo many sick folk.

My ER, nay, the entire hospital, has been bursting at the seams for weeks on end.  Not with flu, although there is plenty of cough, cold, sore throat, etc.  It's chest pain and abdominal pain and COPD. Plus falls, elderly gone to ground humans who have apparently been targeted by Gravity as easy marks.

The waiting room has looked like Calcutta, without Mother Theresa, for days on end.

We have had three times the usual number of psych patients.  These aren't in-and-out depressions or quick psych admits; they are psychotic or suicidal.  They are lining our hallways.  Some wait a week, two weeks, almost three weeks for a commitment bed. They are acting out and who can blame them, it is not a therapeutic environment and their soul-sucking behaviors not only distract us from legit sick people, they make it dangerous for the staff.  The screaming, cursing, button pushing, stretcher banging, shit throwing behaviors….I can't concentrate.  The patient load has increased, management  could care less that the work assignment is sometimes doubled because "they aren't much care".  The fuck?  They need meds, make endless demands, and with each request the patient sitters pass it along to the nurse.  I am concerned about making mistakes because of the distraction.   They have added a part time psych nurse practitioner during the day, but are not staffing the night shift with social workers at least 3 nights per week.  If you come in suicidal at 5 PM, and there are a couple of people ahead of you for evaluation, forget it.  You will be medically cleared by 7, but after 10 they won't see anyone else and YOU will have a cozy bed in the hallway for the night listening to the cacophony.

I get that there is an opioid crises, but we are seeing one or two heroin overdoses a day, about 5 drunks, a sprinkling of people looking for detox,  and 9 or 10 depressed patients with suicidal thoughts at minimum. Add in a couple of actual psychos off their meds and arriving with cops and commitment papers and we are well over the edge.   I am not a psych nurse, I don't have the temperament, I don't enjoy it,  I'm not trained for it.

 I can't wait for retirement and it is still a few years away.

This is winter.  It's here and it's not going away.

Friday, December 16, 2016

Why we're depressed

I brought a patient in from triage and gave her to one of the Kids on the medical side.  "This woman is the prototype  for Debbie Downer and Eeyore".

"Tell me".

"Every question leads to a tale of sorrow and woe.  Ask her any question.  Anything.  It will be the worst thing that has ever happened to anyone.  Ask about allergies?  I get a list of 20, and I had to hear about Every.  Single.  Reaction.  Each reaction lead to another set of complications.  Each complication to a debilitating condition.  Each condition to an endless series of Unfortunate Events.  And then there was a fire in which all of her oxycodone was burnt up.  It took me 39 minutes to triage her.  I feel like all the joy has been sucked out of me and all the fairies are dead. "

"So you're saying I'll never smile again.  Damn"

Thursday, November 17, 2016

Most days the ER is chock full of frail elders accompanied by family members whose mission is never, ever to let their  mom or dad die.  Nobody wants to say goodbye to a parent.

Even if it means doing unspeakable things to keep them alive.

To be clear, "alive" is not the same as "living".  Something everyone should think about.

So it was cool to have 91 year old ex nurse as a patient with all of her marbles, a sense of humor, and a cool daughter who was happy to let me be her mom's nurse.

Over 70 years ago (SEVENTY!) she went entered "nurses training" as it was called.  Now, nurses are "educated".  Think about that while you and ponder why endless courses in nursing theory is absolutely relevant to caring for patients.

There were some surprising similarities in our history.

 "I worked as a secretary for a couple of years, then got bored.  If I had gone straight out of high school,  I would have been finished with my training in time to serve in the War in some way, but it was over before I finished."

My plan was to finish nursing school and join the military (Navy was my preference), and go to Vietnam.  The war ended in my first year of school.

"I worked in a Veteran's hospital for awhile.  Those guys worked really hard to get themselves on track.  It wasn't easy".

I worked in a rehab right out of school.  Then I married a Vietnam veteran

"Of course when we were in school, it was the students who staffed the night shift.  There was no way they could have functioned without students.  God I hated night shift"

Me too.  As a student I worked as an aide at night, or "sat" as a private duty.  I could study or read while rich geriatric patients slept.  The night nurses were all young and mostly new grads.  They were cool.  They warned the students when the dreaded night supe was near.  She was mean.

"The only thing I never, ever wanted to do was work in maternity.  All those screaming women, vaginas and crying babies, no thanks"

My sentiments exactly.

I helped her up to the commode.  When she was ready, I rearranged her things that so that she could get back into bed. "Wait, I have to put on these godawful granny panties".  Note that they were granny panties, not Depends.  I loved her.

Of course many of these older adults are quite funny. I had another 90-year-old who, after being transported for being lethargic (note: she had already been given her nighttime medicines including sleeping pills)  suddenly awoke and demanded food. "What is there to eat around here?" She asked .

Me:  "well I can go and look and see what there is in there kitchenette. I might be able to find you some pudding".

Granny:  "Pudding??! Pudding is not a friggin  meal!"

Run for it, Marty!

One of our docs is deadly slow.  He has one speed.  He cannot be rushed.  He cannot be compelled to move at any other pace than that which he sets for himself.  There is no emergency that cannot be handled at a steady rate.  I have never heard him raise his voice, become rattled, sweat, bark at staff, or handle any issue without careful thought and consideration.

We do a lot of protocols when its busy anyway, even more when Dr. Glacier on.  Although you gotta love him, he is brilliant, loves to teach (be it medicine related or any one of millions of interesting factoids).  His lack of speed is not the most admirable quality when the patients are piling up.  The other docs kind of resent this practice and have a tendency not to pick up charts as quickly when one of their number is seen as not pulling their weight.  Thus resulting in a lot of waiting as the charts are racked.

Auntie is particularly annoyed by this.  As the resource/charge she becomes frustrated when departmental flow is at a standstill and dispositions grind to a halt.

Auntie directed yet another ambulance to park their haul to a hallway bed for the third time in 10 minutes.

"If he moved any slower he'd be moving backwards!", she fumed.

Which is what makes time travel possible.

Wednesday, November 16, 2016

Help me. Please.

I love the front desk clerks.  They are really good about alerting the triage nurse about which patients have checked in with chest pain, shortness of breath, or who "just don't look good".  They are also really good at pegging the drama queens such a those who drape themselves over the desk panting and moaning.   The clerks have a supply of surgical masks to offer the rudely coughing public as well as Lysol wipes.  I don't really blame them for wanting these patients out of their work area expeditiously.  I don't want them in my work area, either.

They are also really good at deflecting the Perpetual Complainers.  I never mind when they tell people "I'll have the nurse speak to you".  But mostly they can handle things quite well.

They see all, and know many of the repeat offenders who cause problems.  They quietly alert our Security team that they may want to "stand by", just to have a presence.  Or the police.

But once in awhile someone is manning the desk who has little experience or is just a tad clueless.  Or both.

Eva.  Sigh.

Eva will interrupt ongoing triage assessments, EKG's and private conversations for anything, no matter how mundane.  Chest pain?  Yes, interrupt me.  Shortness of breath?  Absolutely interrupt me.  Can I get a blanket/water/cab voucher for the lady in the wheelchair?  Hell no.  Not now, dear.

The other day Eva froze solid when I asked her to call a help alert and security for a patient who was "unconscious and not breathing" in a car.  "And call out back for some Narcan", I called as I went out to save another life.

Help didn't come for a couple of minutes.  Waiting.  No help alert.  Just me and the cyanotic  unresponsive patient and the female in the back seat who was helpfully filming the entire experience on her cell phone. As I held open his airway the driver of the car, who claimed he just found him unresponsive and didn't know him, helpfully urged me to "just get him out of the damned car, bitch!"  Security was busy putting yet another out of control, dangerous psychotic patient in four-point restraints.  "Narcan!" I hollered to my co-worker who was pushing a stretcher up the incline.    I recognized the patient from a previous appointment with death 3 days before, also miraculously saved by interventional Narcan.

Eva and I had a little discussion about what was meant by a help alert, and NARCAN.

"I just thought you meant I should call back and get you some help. I didn't know I was supposed to tell them someone had stopped breathing.  And I asked for someone named something-Ann, but. They didn't know what I was talking about because Ann doesn't come in til later".

Sigh.  On the plus side the patient lived, his Appointment with the Reaper postponed. For now.