Monday, June 20, 2016

Take a breath


If you can say the following sentence:

"OMG I am so short of breath it's been going on for days I just haven't had the time to contact my doctor about it so I decided now would be a good time but I had to get my kids a snack after I picked them up at school and on the way over and an iced coffee in case it was going to be a long wait JARRED GET OFF THAT CHAIR AND HOLD ON TO YOUR SISTER,  DARREL PUT YOUR SHOES BACK ON TOYA DON'T PUT YOUR FRENCH FRIES ON THE FLOOR and then I forgot my my phone charger do you have one because the kids used up all my battery how long is this going to take?"

you are not short of breath.

Thank you.

Friday, April 22, 2016

Ambulance patch of the day

"……72 year old patient with history of Ebola….".  

I exchanged a dubious look with my partner.

"Wait for it",  I said.

"Correction.  Pt has a history of ecoli".

I love those guys.

Friday, April 15, 2016

New girl in town

There have been a lot of nurses hired in the last couple of years who have the same first initial.  Frankly, I have found it difficult to keep all the kids straight.  Maura, Mary, Merry, Maisie, Mac, Myra.    But they are a good bunch of ER nurses, smart and young they are.  We dinosaurs are still in the fight, but less prevalent on the off shifts which I prefer to work as the others have gone on to work  day shift.  So it's me and the "kids", 20 somethings to 40.  

Several months ago Susan was hired, with lots of experience.  She is around my age and has a similar haircut and glasses.  Lots of people have been getting us confused.  Which is disheartening since she outweighs me by a good 30 pounds.

One night at least 4 people in one hour, notably all the social workers with the psych patents, approached and started rattling off info about their oh-so-important revolving door suicidals and acting out teenagers.  "Nope", I said.  You want Susan.  I'm Regina".  Off they toddle to find her.  No, I don't know where she is.  With a medical patient most likely and not fixing a meal tray for your entitled douche bag who lacks coping skills.  

Marge is a social worker without any adult social skills, I have no idea how she keeps her job.  She barges in on any conversation and actively seeks out nurses in patient rooms in order to do some sort of emergent phone retrieval, take orders from a psychiatrist, or call report RIGHT NOW to the receiving psych facility.  Doesn't matter if you are in the middle of a code or mixing meds.  
She annoys the shit out of me.

Therefore, when she started to rattle of the latest  ridiculous needs demands for her critically ill attention seeking revolving door suicidal pt, I simply put my hand up in a "stop" gesture.

"Marge", I said. "I am Regina, you want Susan.  She is the other red-headed middle aged fat white woman wearing glasses on the floor tonight".

She spluttered, turned red, and walked away.  

Really it's not that hard. We have ID badges the size of dinner plates at chest level.  

Wednesday, March 9, 2016

Dear patient who went to the Urgent Care..

…because you have had chest pains for days and your doctor told you to go to the ER.

During your stopover the Urgent Care you had an EKG which was proclaimed "fine", whereupon you were instructed to go to the the actual ER (us) "for further testing".  You arrived by private motor conveyance, which by all accounts does not qualify as an ambulance thus indicating that you did not require advanced life support or monitoring.  I understand that this particular urgent care DID offer you an ambulance as a precaution, which you vehemently refused.

Just so we are clear, you are not, at present, having a heart attack, based on the EKG I completed in the triage area.  That is our policy.  An EKG done outside the hospital in a doctor's office or urgent care center we don't trust (pretty much all of them) gets an EKG.  Sorry, policy.  Also, the urgent care should know to tell you (but apparently doesn't) to leave all those little stickers on your chest.  This would be important in order to compare any subsequent EKG's.  But you took the time to take them off, so….moot point.

I fully understand that "chest pain is an emergency!", a fact that  has been ingrained into every cell in my body and seared on what is left of my soul for the last 40 years.  Please understand that head trauma, stroke, and hemorrhage are also emergencies, and the patients who are experiencing them have arrived in an ambulance through the back door in the last 15 minutes.  Please note the onset of their symptoms was not days and days ago.   There are also 4 other chest paineurs ahead of you, as well as several others who are experiencing other serious symptoms that also deserve immediate care.

I will listen politely to your ranting and threats to call my boss, but please refrain from haranguing my front desk clerk.  She is busy assisting other patients and has wasted enough of her time dealing with your nonsense.  Shortly,  I will be happy to check your vital signs again and reassess you.  While you sit in the waiting room until a bed is available in the ER, I will have your blood drawn for cardiac markers, and, following our protocol, and have alerted my resource that you are here.   However, you have arrived at a very busy time.   I can not create a bed where non exists.  I can assure you, based on the assessment of my physician, that you are not presently having a life-threatening emergency, and we will get to you as soon as we possibly can.

As an aside, no, I have no interest in speaking to your doctor, but I know that my charge nurse did.  He most certainly did not tell her to "get you in to a damn room right this minute".  The conversation between your doctor and the charge nurse went thus:

Doc: "Hi, I know that my patient Mr. X is there.  He is calling me from the waiting room, he's a bit of a pain.  Can I tell him that I called and spoke to you?"

Auntie: "Sure.  You can tell him there are 4 chest paineurs ahead of him, plus a trauma and a stroke.  He had a EKG, in fact 2 that are within normal limits.  He has labs pending.  It's gonna be awhile."

Doc: "I know you're busy and will get to him when you can.  Have a nice night, and I'll bring donuts next time I come in".

Auntie: "Sure, thanks for calling".

How I wish I could tell you that.  But, that is my burden to bear.

Now, please just take a deep breath and have a seat.  Waiting sucks, but patient patients are a virtue.
Thanks for your kind attention to this matter.


Tuesday, March 8, 2016

Man Baby, a cautionary tale

My latest needy patient, the dreaded Man Baby, reminded me of one of Hood Nurse's epic posts from a few years ago.  It is both hilarious and sadly true.  I miss Hood Nurse's regular posts, she is a badass.  You should go and read this, right now.

So, my patient, fat and bald and a self-professed wimp.  A man baby of the first order.  Clearly he did not do much for himself even on those banner days in which he was fit as a fiddle.  This was a middle aged man who had arrived by ambulance after vomiting once with a "high fever" of 99.5.   Wow.
 "I don't feeeeeeeeel goooooood", he whined

FYI, whining tops  my list of "Things I Hate".

 Mommy-wife enabler accompanied him, soothing his brow, holding his vomit bag (for him to spit in, for Man Baby never vomited), asking for warm wet washcloths to moisten his lips, and requesting juice, (no), crackers (hell no), extra blankets, and of course "one more thing to ask the doctor".  Plus she was a helicoptering monitor-watcher.   "Why is that monitor alarm going off!?  Is his blood pressure ok??  What is that number?? What's wrong???"

Well.  Here is the short list:
Mancold, manflu, man-monia (unlikely).

 Or a rare fatal disease (also unlikely).

Absent anything being found really wrong, I'm liking the all encompassing manvirus as the culprit.


You will get better, or you will die.  Going way out on a limb here, being a stupid nurse and whatnot, but guessing today is not going to be the second date (the one to the right of the dash) on your gravestone.

He was given the panacea for all ills when it is not politically correct to kick patients to the curb within 10 minutes of arrival:  IV fluids and Zofran.  In a 12 hour shift I will personally execute these lifesaving orders about 10 times.  That is just one nurse.  There are lots of others who will be saving lives many times over this shift, one bag of normal saline and 4 mg Zofran at a time.

He was there for a couple of hours, moaning, watching TV, texting on his phone, sending the little woman scurrying for ginger ale and ice, and arranging his other chargeable electronics.  He was pretty busy.  Eventually he was given the good news that he did, in fact, have a virus.  Since he had not vomited, his vitals were completely normal and was drinking  ginger ale, there was nothing more to be done for him.  Also, once a patient who presents with vomiting has asked for a meal tray, his status automatically defaults to "discharge pending".

He was shocked.  "I don't think I can go home like this".

Trust me, read your instructions,  "you will get better.  Drink lots of fluids, rest, take tylenol for headache and fever, here is a script for some Zofran.   Now get out and man up "

Mommy-wife will take really good care of you, maybe order out some Chinese.