Monday, July 21, 2014

This Post Brought to You By the Letters : A, B, C….

It's been my week for unhappy patients.  I collect them like dust.   Would that we could devise our own survey for difficult patients, wouldn't THAT be a hoot.

Some people just hit the door itching for a fight, pre-programmed to have some kind of issue. These individuals quite frequently come with potty mouth, bad manners, and a lack of patience in general.    They are disrespectful of staff and other patients.  Maybe it is defensive, based on a past experience or just having  a bad day in general.  I get it,  for many people it is literally the worst day of their life.

Or maybe they are just an entitled A-hole.

Regarding the Worst Day people, I give them a lot of slack and take it in stride.  As for the others, not so much.

A-holes seem to have a lot of similar characteristics, many of which, interestingly enough, begin with the letter A.  The Big A.  Which is just the beginning of the alphabet.

Some lead off with a clearly defined AGENDA, and  are often ARGUMENTATIVE.
They know exactly what they want, even if it is ABSURD.

 Some have lots of ALLERGIES.
 Usually to NSAIDS or every narcotic except Dilaudid.

Often they ANTICIPATE a fight for what they want specifically, and use words like "horrible bedside manner", "letter to administration", and "calling my lawyer" when they don't get it.

Lots of patients become a strong  ADVOCATE for their pre-determined diagnosis and treatment plan, no matter how bad an idea it might be.  It has all been spelled out for them thanks to Dr. Google (note:  I am not talking about informed patients who have done some research.  Calm down.).  They simply need a provider to write for their desired antibiotics or a therapeutic X-ray.  Some sign in to the ER with the complaint,  "Need an MRI".  They do not get one.  Hilarity ensues.

ALIBI  is not a reason to come to the ER, but it happens a lot.  Roommate stole your Adderall?  Need a prescription refill?  Need documentation for missing a court date?  Too busy to wait for a PCP appointment for rash cream?  C'mon down.

Rarely, after using foul language and creating a hostile atmosphere which does not produce the desired outcome, there will come an APOLOGY for their bad behavior.  Not often.

Moving on, I present my top selections of the letters B-E.

Talking smack and BADMOUTHING about previous providers who did them wrong, be it in the community, another hospital,  may have fired them for being an A- hole, or not helping them just because they broke their pain contract.   Also they may refer to the last nurse who started an IV on their track-mark tattooed arms "that bitch that stuck me 11 times".  

CUSSING:  Uses the F bomb a lot.  Complains about "the wait is f*cking ridiculous, my f*cking pain is f*ing out of control, this place is bulls*it".  They don't "f*ing care if it's busy" or if people in the next room are trying to die.

DEMANDING, DILAUDID, DISRESPECTFUL, DRAMA:  The first two self explanatory.  Some examples of DRAMA?  Sighing loudly.  Moaning loudly.  Banging the sides of the bed.  Yelling out to the nurses every two minutes.  Throwing themselves around on the bed.  Whining, lots of that.

EXPLANATIONS, in which the patient is intent on convincing everyone that their particular problem is an original complaint, never before thought of in the history of scamming for narcotics.  The pain scale does not apply to them, and usually it is 11 or more.

FAKE CRYING: See DRAMA.  I need to see actual tears.  Sorry.

I could move on to the rest of the alphabet, but….nah.

Friday, June 20, 2014

…and then there were three.

Jobs.  I have 3 jobs.  I was hired back at Pseudo City, a job with plenty of action.  And help.  Lots of help.  I had forgotten what it was like to have transport techs, LNA's, and paramedics to work with.  Not to mention lab techs, EKG techs and, joy of joys, an actual pharmacist to do the med reconciliation on the admissions.  Bliss.  Busy, of course, being 3 times the size of BWOM Hospital and 6 times more beds than Scary Hospital's Bait Shoppe when it was an ER.

I was welcomed back by my old nemesis, Dr. Dewshe Bagghe.  He lifted an eyebrow and patted me on the shoulder.  "You're back?"he said wryly.

"I missed you terribly Dr. Bagghe" I said sweetly.

"Well, (he grumbled). Welcome back".

Of course, each new job requires an excruciating orientation.  Oh, the pain.

And because I am a glutton for punishment I was also hired back at the Bait Shoppe turned urgent care.  My severance ran out sometime in February or March, but my former co-worker who is wearing the boss hat  is now on-site supervisor and begged me to reapply so I could do some per-diem.  I really just wanted to tell them to stuff it and that was, in fact, my plan.  I figured they would low-ball me on the money but was shocked out of my clogs when my offer letter was for money than I was making, plus the raise I would have gotten had I remained another 25 days.  At $10 more an hour than BWOM I couldn't say no.  I did make it clear that I would not be working 12 hour shifts.  It's right around the corner from my house, easy money.

Except for the excruciating one day orientation even though I had only been gone for a few months.  I have had co-workers who were out on medical leave for longer than that.  So I had to spend a day sitting through useless shite.  The upside was that we were given a pass for the entire day to both the cafeteria and coffee shop to get whatever we wanted for our MANY breaks, as well as a $5 gift certificate to spend at the gift shop, which I rapidly used.  I did have to coach the poor little elderly volunteer how to make change as she seemed completely flustered.  Thankfully that is a skill I was taught by my father ("always count it back!") and I managed to make her feel confident for next time.

So, yeah, three jobs.  It's been awhile since I have had to juggle like that, but since I am not a tremendous fan of BWOM, I am doing very little there.  I probably will not last the summer, but feel kind of bad since they are in the process of a staffing crisis.  Clearly, where there is a staffing crisis, there exists unhappy staff.  Almost everyone there works at least 2 jobs, so maybe they should look into increasing the pay.  Just saying.

Thursday, June 19, 2014


The term "LOL",  before gaining widespread popularity as an acronym for responding to text messages and emails for which we are too lazy to write a proper response,  had another meaning   LOL= Little Old Lady.  At least in health care.  Of which there is an abundance at BWOM, a distinctly aged population, this hospital.  On any given shift the department will have a uniformly unhealthy selection of patients in their late 80's, 90's or even a scattered centenarian awaiting admission or transfer.  There are a lot of nursing homes and somewhat upscale assisted living joints.  There are lots of gravitationally challenged elders.  Lots.  Everyone sports yellow socks, yellow bracelets, and cute little yellow "falling stars" on the doors of the rooms for fall risk.  "Yellow socks for LOL's cause they will fall"

One LOL was brought by the usual contingent of  Entitled Concerned Family Members having become increasingly weak at home.   She had taken a fall several days earlier and evaluated at the ER (not ours) and sent home with family.  She did not do well.  She refused to eat or drink, take the pain medication, or participate in her care.  I don't know how the Entitled Concerned Family Members got her into the car, but it was necessary to lift her bodily out of the front seat by one of my heftier co-workers and was marked for admission within the first 3 seconds of her visit.  

As previously mentioned, the admission ritual is pointlessly lengthy.  There are also two issues that make the process just that much more difficult: the layout of the department and the happy bunny concierge service that management insists we must provide, even it if means that actual stuff we're supposed to do is not done in a  timely fashion, let alone properly documented.  I have many times stayed hours after my shift to document.  It's crap.  But I get paid overtime. Don't bother complain, Boss Lady.

It is often necessary to work around all the Entitled Concerned Family members who hang out in the room and think nothing of coming out to the desk and asking for everything they can think of under the sun.  The physical lay-out of the department is moronic.  Juice.  Crackers.  Pillows.  Warm blankets.  5 more warm blankets.  Reposition.  Toilet.  Toilet.  More juice.  Cardiac monitor beeping.  Concerns about BP.  Concerns about o2 Sats.  When will she go upstairs.  Can she have pain meds.  Can she have blood pressure meds.  Can she have tylenol. Will you recheck her temp.  It is a constant barrage; nothing gets done and woe if I have other patients to take care of with equally demanding Entitled Concerned Family.

The two nursing stations are placed back to back, but with the doc's dictation room and pyxis / med room in the middle.  You can't communicate well with the secretary.  The problem with the placement is the proximity to the doors of patient rooms which is less than 8 feet.  It looks like a bank, but with low counters and no bullet proof glass.  It is not possible to have a private conversation, speak on the phone, communicate with providers, or in any way follow any patient privacy policies.  Like all nurses,  I usually have a couple of  situations going at one time.  Consider juggling three bowling balls and a chain saw.  It is exhausting.  The desk placement makes the nurses sitting ducks for anyone with a questions or request;  ALL  the Entitled Concerned Family members  think nothing of coming over to the counter and asking for everything they can think of under the sun.

 It is NOT OKAY to interrupt constantly.

Herewith, my open letter to same.

Dear Entitled Concerned Family Members:

Let me just make a comment about why I am sitting ever so briefly at the desk.  It is not for your convenience.  It is not the check-out counter at the market.  It does not say INFORMATION in bold neon letters about my head, nor does it say HANG OUT HERE.

Please note that there is a computer, a centralized monitoring system, and a phone.  There are other personnel with whom I may be speaking about other patients; what she and I are speaking about is not only none of your damn business, but a violation of the privacy rights of other people.  We do not have the Cone of Silence.

What I want you to know is that while I would love to spend each and every moment of my evening with your loved one, you and your family members are rapidly sucking the life right out of me, as well as every ounce of empathy.  Your very nice but markedly demented grandma has been toileted 4 times in the last hour (3 of them needlessly because you keep asking her if she needs to go.  She's demented.  She says yes).  Turned her.  Given her water, juice, and a snack.  I have acceded to your requests for warm blankets and more pillows.  I have put all of the chairs into the room that are appropriate for the 2 allowed visitors even though there are 5-6 and I am stepping around them.  I have been into the room to address each and every variation of blood pressure or heart rate that has concerned you and reassured the lot of you that I am indeed keeping an eye on it and there has been nothing dangerous or even noteworthy about these variations.  I have relayed each of your requests, comments, concerns to the treating physician.  I would love to get her medication for pain but THAT ORDER IS IN THE COMPUTER AND I NEED TO SIT AT MY DESK IN ORDER TO ACCESS IT.  I also need some consideration for figuring her dosing and you keep distracting me.  It is dangerous.  I think she needs those packed cells more than another warm blanket.

I do not know when the floor will be ready to accept grandma.  Again, addressing that situation requires me to be away from the bedside for more than 30 seconds at a time while you dream up yet another inane request. Before I can consider giving report, I must call the pharmacy to get a complete list of her medications because you didn't bring one, assuming that "we have it in the computer".  We do not.

 I am sorry grandma is not feeling well and you have had to sit by her side for the last four hours, but really, I have this.  You guys apparently did a shitty job of taking care of her needs at home, why don't you all just go away now and let me have a crack at her.  You are so busy making sure that all the bases are covered that you are not letting her rest.  Now, beat it.

Yours Truly,

Wednesday, June 18, 2014

Tales from the Crib

Babies.  Hate 'em.

Well, not really, just don't like 'em in the ER cause it's generally no place for a healthy child.  There are few reasons to actually bring your young baby to the hospital.  Obvious reasons notwithstanding (AKA life threatening or extremely troublesome symptoms that cannot wait for an appointment), about 90% of the babies we see in the ER have no need to be there.

Mosquito bite.

Low grade fever absent other symptoms.

Diaper rash.



Vomiting if you have reloaded your child with Hawaiian Punch every time he spits up.

I can't even talk about every kid who ever played a sport and bumped his head on a Nerf ball.

One mother brought her pink as a rose 9 month old by ambulance.  This followed a visit to urgent care, as well as another visit to their pediatrician where she was told the child had an ear infection.  She loudly complained about both of those visits, calling the pediatrician "stupid", and the urgent care "idiots".  No, she didn't give the kid with a temp of 100.2 any tylenol.  No, she didn't fill the prescription for antibiotic.  No, she didn't bring diapers, formula, or clothes.  She refused to let me take a rectal temp.  "He as a diaper rash".  Um, ok.

The kids was bright-eyed, playful, beautiful.  The mother held him and rocked him but was more intent on being on her phone.  In a perfect world, no patient or visitor cell phones would work in the ER when health professionals get within 3 feet of them.  Some sort of jamming device would be nice.  Thank you to all the patients and visitors who actually ask if they can use their electronic devices.

The PA spent a LOT of time with her, going over tylenol dosing, being specific about when she should give the child meds, and in general providing her with the one thing the child would benefit the most from aside from a parent with an actual brain:  education.

I really don't know what she wanted, possibly for the child to be admitted so someone else could take care of him.  Between the two of us, the PA and I, we gave her formula, med syringes clearly labeled, diapers, wipes.  She got fed a meal.  Still, after being discharged the registration clerk came back to let me know that the mother was out at the front desk, talking loudly on the phone, complaining that her child got crappy care and "she needs answers now, and she got nothing".   You just can't fix stupid.  The kid is doomed.

Tuesday, June 17, 2014


It happened so fast, yet I recall the details like it was slow motion.

I jumped up from my computer at the request of a family member for food for their entitled loved one.
Feet get snagged by my tote bag, which had become entangled in my chair.  I was going down, down, down.

I instinctively tried to employ tactics learned from years as an adult not-very-good figure skater.  Go with it.  Protect the head.  Try to slide.  Unfortunately not always transferable  to unfrozen surface, but better linoleum than pavement.

I managed to slide into the side of the waste basket, making a racket and commanding far more attention than I wanted.  "I'm OK!"

Unharmed except for my dignity and a dinged little finger.

So yeah,  I have a new nickname at BWOM.

Mary Katherine Gallagher.