Thursday, December 31, 2009
Usually on holidays, you get the extreme version of the Sick and the Stupid.
To recap, the Sick consist of any patients who should be in the ER; that would be lacerations that require suturing, chest pains, head injuries, fractures and the like. The Stupid are those patients who should emphatically NOT be in the ER for any reason; that includes rash for 3 weeks, any chronic pain, fever of 100 degrees as the chief complaint, ear wax, or any who has a doctor's appointment the same day but just doesn't feel like waiting.
As I said, on holidays it is the extreme version; REALLY sick or REALLY stupid. This I categorize as complaints that range from Illness to Idiocy. Same rules apply.
The gentleman who should have been in the ER like yesterday for blood sugars above 600 would qualify, as well as the man who nearly severed his thumb while decapitating Mr. Thomas Turkey, AKA, New Year's day dinner, with a hatchet. Nothing like fresh poultry I guess....hmm, what is that in my stuffing? Thumbthing wicked this way comes.... Honestly, who has turkey on New Years Day?
So I was more or less prepared for trouble when one of the local regular customers strolled in. At least he waited until we had dinner. He is known for being rude, often aggressive and I have personally thrown him out at least once. He got into it with the doc in the past because the doc wouldn't write him a 'script for 120 Valium like the last doctor. WTF.
Tonight he complained of a rash, convinced it was bedbugs, or hives, or MRSA, or plague.
He is especially nasty to women, and we usually try to protect our secretaries from his bullshit because they are all really nice and don't deserve it; not that anyone does. On the other hand, he has had a run-in or two (and been thrown out) by my usual co-worker, AKA my "work husband", Dan; he is 6 foot 5 and takes no bullshit from anyone. Dan was already ramping up as soon as he caught sight of the guy so I went in to triage him. Must have been a good day for him because he gave me no trouble; asicd from failure to make eye contact, which drives me nuts.
As he passes by Dan, he mumbles to his friend "That's the guy gave me bullshit last time I was in here"; Dan rises to the occasion and returns fire, "Yep", he says, "I recall you told me to polish up my resume; I'm still here".
I cringe and resist the urge to dive! dive! dive! under the desk.
The man and his friend get all huffy so I took the higher ground. "Why don't you have a seat in the room, the doctor will be in to see you shortly; we all just need to be respectful of each other and you will get your problem taken care of" I offered.
They grumbled into the room, he got his 'script for prednisone and hydroxyzine for his itchy pseudobugs or MRSA or galloping crud, and went outside to smoke.
"His companion wants to check in too", said my doc of the eve.
The 20 year old female claimed the guy as a family friend. Her complaint was abdominal cramping; she was 4 months pregnant, having discovered this fact after taking an ambulance ride downtown to our mother ship in the last couple of weeks for the exact same problem. No prenatal care. No insurance.
She had not followed up with an OB as instructed. I quickly deduced that she wanted pre-natal vitamins and an ultrasound...in other words a picture of her baby.
She was a little skittish. I entered the room to draw her blood, and she decided she felt really nervous and wanted to step outside for some fresh air.
"Just a few minutes, though, OK? If we need to send you downtown (for an ultrasound) we should get this show on the road"
I waited about 10 minutes and decided she needed a kick in the ass; I went out the door to discover her smoking a butt.
I coaxed her inside and prepared my various tubes and assembled equipment, and explained what I was going to do. She proceded to tell me what awful veins she had and how she was terrified of needles and how "sum nurse" dug around for her vein for over and hour trying to draw blood.
Uh huh. I love a challenge and nothing gives me more pleasure than a successful venipuncture on the first try; I rather pride myself on it, actually. I attribute my success to the countless pedi IV starts when I worked at Utopia Hospital.
But I digress. The young lady said, "I'm just really anxious about my baby, I am scared there might be something wrong with it".
"If you are really concerned about your baby, you should quit smoking immediately".
"Well, I've really cut down since I found out I was pregnant".
"Your baby doesn't know from cutting down. You are at risk for having a low birth weight baby. Do you know what that means?"
"Having a small baby? Wouldn't that be better for delivery?"
Arrgh. This kid is doomed.
As the festivities began to wind down we were hopeful that we might get out at 11PM, our usual closing time. I triaged a sore throat at 10:20 PM, then a febrile, inconsolable, wheezing 8 month old who was afebrile, sleeping and had no wheezing. But did have an ear infection and didn't wake up during the exam or when I put Oticaine in followed by a cotton ball.
At 10:40 PM local EMS was toned out for a lethargic 4 year old with special needs, not otherwise specified. We know most of the medically fragile kids in the area and the address we heard over the scanner was unfamiliar. Moments later, we heard that CPR was n progress.
"Should we stick around to see if they need to come here?" I wondered aloud.
"They know what time we close", offered the secretary.
"I know, but a pedi code is anxiety provoking, they won't be thinking about it in the field", I responded.
I asked our doc who was an ex Greatest EMT in the history of the world, before he went on to become World's Greatest Paramedic before he got kicked out of the Air Force Academy for being a big mouth, followed by the designation of Most Intellectual ED Doc in the Universe. But good to work with when we can keep him focused.
"Wait and see".
By 11:05 PM we had heard nothing. "We're closed" said our doc. I wasn't sure, but it was his call. Still, we knew he would sit in the parking lot for a few minutes.
Since we nurses and other lower life forms park out back in a lower parking lot, Lisa and I made our way down the back elevator, alarmed the building and went outside into gently falling snow. We had gone a half a dozen steps across the lot when we heard the siren. Lisa and I froze in our tracks. The ambulance approached, got closer and louder. I fumbled in my coat pocket for the key and tried to remember how to disarm the system to get back inside as I listened.
We held our breath. One block away. Outside our ER.
And continued toward the city.
Wednesday, December 23, 2009
"What?", I asked, busy warming my hands in front of the pellet stove.
"This discount card from your hospital. You can go online and print discount coupons and look for deals at a bunch of different stores and restaurants. It says 'Perks Card' ", he said
Like what?", I asked, becoming interested. I hardly ever read anything that comes from my hospital.
"Well, let's see: Dougie's House of Onions, Sally's Books 'n Toasters, Elemental Crankshaft...um, Lamps, Socket Wrenches and Diapers's, ... and Arby's".
"Big Whoop. I never heard of any of those except for Arby's, and I don't think there's one of those for 50 miles...why would I even bother?"
"I thought you might be pleased since the hospital cut your educational reimbursement by 50% and your shift differential fifty cents an hour", my husband replied, not without a note of sarcasm.
Ah, I thought, he's baiting me.
"OK, I see where you're going with this. For one thing, it is no skin off their teeth if they give discounts to obscure places that nobody ever goes to; in fact, I find it insulting. You can put a turd on bread and call it lunch, but it's still a turd".
It's still a big old stinking turd.
I'm still pissed that Scary Catholic Medical Center did both of those things as well as completely cutting the employer contributions to the 401K. These occurred after the Magnet Survey in August
Magnet Recognition is a designation bestowed on any hospital that works hard enough to jump through the necessary hoops. It is given by the American Nurses Credentialing Center (ANCC) , a wholly owned subsidiary of the American Nurses Association (ANA). Magnet Recognition is given to a hospital that "satisfies a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment". (From the Center for Nursing Advocacy).
It's a lot of documentation, and sounds like it should be a good thing. I guess it is except that the astute nurse recognizes it as window dressing. Nurses are largely brain washed into into thinking that a Magnet designation is anything other than a marketing tool. Those nurses are then lined up, questioned by the representatives of the ANCC who are convinced that the candidate hospital is the Best in the Entire World in attracting and retaining the World's Best Nurses because the hospital cares deeply and passionately about Nursing Issues.
I was forced by my nurse manager to attend a Magnet Dinner; there were about 12 of us with 4 Magnet Representatives. After we finished rubber lasagna, wilted salad, soggy garlic bread, and soda, the examiners went around the room and asked each of us; where we worked, what projects we were involved in, what educational or leadership expertise the administration had encouraged us to participate in and what UAC's we were involved in.
Let me put it this way; I go to work to earn enough money to pay for my expenses. After 33 years, I feel pretty much as if I've done my time with Unit Advisory Committees. Waste of time. I have all I can do to do my assigned hours, attend an occasional staff meeting, be a mover and shaker behind the scenes and scramble to complete my BSN before I chuck the entire plan and follow my friend Anne into hair dressing. Really. Or learn to play the drums, whatever.
To the Magnet representative I spoke about my years of nursing experience in the ER at various levels from staff to leadership positions, went on at length about completing my nursing education and plan for grad school and ultimately teach nursing in some capacity. I spewed some lie about working on a nursing assessment form that pretty much everyone had worked on as well; I recognized a nice young ER nurse from our mother ship and dragged her under the bus with me as I said, "Erin, you probably had lots of input in that too, didn't you?".
Erin grabbed at the lifeline as she clearly had no UAC commitment either and rambled her own bull shit. I silently flung the bird at my nurse manager for putting me in this position.
Two weeks before the hospital got its Magnet designation, the aforementioned budgetary cuts were made; all affected clinical nurses. While merit raises were cut, no management positions were cut, reduced or eliminated. No administrative positions were eliminated. No administrators took a pay cut. This is a demonstration of how much a Magnet Hospital values its nurses.
Magnet my ass. Use the nurses for gaining some sort of marketing edge and then, in this economy cut tuition reimbursement and pay. Yikes.
I can't wait for the Magnet Peeple to come back, but that will be a few years.
The hospital is, however, required to conduct satisfaction surveys either once a year, or once every two years. They can pretty much depend on me to lower their satisfaction scores.
I just love surveys. The first couple of surveys I completed I complained about the crucifixes in every treatment room; that and the joining of hands, being forced to pray and sing Kumbaya at the conclusion of orientation. I though this was offensive in a facility that seemed to pride itself on cultural diversity. How does this welcome members of other cultures and religions while ramming their ideals down someone else's throat?
Within 2 weeks the crucifixes disappeared. Interesting.
Bring on that Magnet satisfaction survey; unless our tuition reimbursement is fully restored, along with shift differential and merit raises. And, while you're at it Scary Medical Center, fire 50% of your administrators and other dead weight. I want the CEO right here tonight. I want him brought from his happy holiday slumber over there on Melody Lane with all the other rich people and I want him brought right here, with a big ribbon on his head, and I want to look him straight in the eye and I want to tell him what a cheap, lying, no-good, rotten, four-flushing, low-life, snake-licking, dirt-eating, inbred, overstuffed, ignorant, blood-sucking, dog-kissing, brainless, dickless, hopeless, heartless, fat-ass, bug-eyed, stiff-legged, spotty-lipped, worm-headed sack of monkey shit he is! Hallelujah! Holy shit! Where's the Tylenol? *
Me, bitter? Nah.
*Thank you Clark Griswold, although I stole this from Jules.
Wednesday, November 4, 2009
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".
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!
Tuesday, November 3, 2009
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.
Friday, October 30, 2009
"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.
Thursday, October 29, 2009
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.
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.
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.
Sunday, July 5, 2009
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.
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.
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.
Thursday, June 4, 2009
Picture this; if you have never seen CPR performed, go to Youtube and try to imagine what this poor young EMT had to witness. Think about this attractive young woman with her back to us, kneeling next to the mannequin in her see-through white capri's, pumping (yes, pumping) from the shoulders and bending at the waist. Up, down. Up, down. Up, down.
Wednesday, June 3, 2009
My ER is quite a magnet for repeat business for dental pain, migraineurs and various other narcotic seekers. It's quite a business.
Some of our docs and a couple of the nurses work at other ER's and see the same people from time to time. It's funny how they kind of just walk out when a nurse who took the same complaint (word for word) looks at the chart and says "Hmmm. I know you were give a 'script for Pen VK and Vicodin last Friday evening at Mt. Seaside. Are you not taking them?"
One girl claimed her backpack was stolen. Which contained her prescription for Percocet. One guy said he lost his prescription (at least his fifth for 20 Vicodin in the last 2 months). Another claimed her 3 year old threw her Percocet in the toilet. And the old standby "I knocked them into the sink".
How refreshing would it be to have someone come in and say, "Look, I'm addicted to painkillers" instead of devising these ridiculous fairy tales. A young guy I remembered from 2 or 3 months ago came in and told the exact same story about how he saw the dentist, he has an abcess and was told to come to the ER for antibiotics (and pain pills) and blah blah it will cost him $700 to pull his tooth and he doesn't have the money. Same story exactly, I looked it up because I remembered he had an unusual name. Funny that this time he had a different last name. He was invited never to return.
We have an unusual group of co-dependent migraineurs. A couple of them take turns driving each other (we don't let 'em drive after they get their fix for obvious reasons). One doc gave a migraineur VALIUM for cripes sake along with 100 mg out of the usual 150 mg of Demerol they normally receive. Now they all want it.
Speaking of driving under the influence of mind altering drugs, one of the chronic migraineurs got her meds, got on the phone for her ride, and said she would wait outside on the bench as he would be right along. OK. We were busy, but I was suspicious. I know what she drives, too, and I checked the parking lot. Nope, no van. No patient on the bench either.
I popped into my bosses office which has an expansive view of the back parking lot where we employees park. Oh, look.....there is my patient 15 feet below me starting her van and driving away.
Oh, doctor, guess who just lied and drove home?
Wanna talk liability?
That's it, he says. She's not getting another narcotic from me, and let the record show that she was observed driving after she said she had a ride.
Three days later she came back, parked her van in the back and got............NOTHING.
This is not to be mean or vindictive. Do you want to put your loved ones, both on and off the road at risk with this nutbag driving with a boatload of narcotics onboard? Didn't think so. I sure don't.
One of our newer docs refuses to give Demerol. At all, which is kind of interesting. She might order morphine, with a Vistaril chaser (which stings like a mad bastard when you inject it I might add). One of the co-dependents now claims morphine as an allergy.
I will say that some of the other docs are interested in coming up with unified plan. We are all feeling like pushers.
Come to find out, without fanfare and without warning the hospital pharmacy had decided to take Demerol out of the formulary as of June 1 (basically a list of meds the hospital carries....we aren't CVS, you know).
Apparently one of the migraneurs was forewarned, and must have thought it meant that we were no longer stocking Demerol in our satellite ER only, because low and behold, there she was on June 1............at the downtown main ER. Hmmmmmm.
Saturday, April 18, 2009
Arriving by ambulance from an assisted living facility complaining of hip pain. She smiled beatifically as she was wheeled in by the EMS crew who had gone to fetch her, her pale little face peeking out from beneath a halo of white blankets.
The crew had gotten to know her pretty well on their brief ride from her facility and let us know she had fallen the night before, but was up and around; there was no overt sign of hip fracture, sometimes a death sentence for the aged. She lived in her own room and was able to get herself to the dining room for her meals; she managed her own medication, contingencies for her assisted living arrangement where there was no professional staff. Up until a couple of years ago she drove a car, but gave up her license following a motor vehicle crash. "Not my fault!" she piped in, bright and alert and spry......although very, very hard of hearing
Sherry and I and the paramedics oh so gently transferred her from the ambulance gurney to the bed as if she were made of porcelain. I can't recall seeing these big guys move someone with so much care. They carefully tucked n her blankets and bid her farewell.
We undressed her with utmost care, and I inspected her soft white skin, so transparent; this skin is 100 years old, I marveled to myself. "It burns", said Alice, our centenarian, rubbing her hip; there were no bruises or swelling as she pointed to the area righ above her hip bone.
"Shingles", Sherry and I mouthed simultaneously to each other.
"Did you fall down ?", Sherry asked. "Yes, I live in town", replied Alice.
I just grinned.
We xrayed Alice's hip and found nothing. We got her up to be sure she could walk; we found a walker so she we could more accurately assess her ability to ambulate. Alice did just fine, and asked to sit in a chair. We covered her with blankets, got her a little snack.
"We're going to send you home! Do you want anything for pain?", Sherry yelled.
"No, I don't like to take pills, not even Tylenol. I'm fine", Alice said in her little bird-like voice. "I want to go home with my daughter".
The local ambulance service is usually one way, and they weren't able to get her home.
We called the daughter. She said she wasn't able to accomodate her mother, and couldn't give her a ride home. That was just as well since I found out she was 80 and probably shouldn't be driving Miss Daisy.
Alice, now that she was upright, called out "Nurse!?" every few minutes. Sherry asked if she would like to sit in our tiny waiting area to watch TV, and she thought that was a good idea while she waited for her ride. We got her completely dressed, again carefully putting on her clothes including her 20 year old Reeboks. Seriously. We wheeled her to the waiting room which is literally 10 feet from our nurses station.
While in the waiting room, instead of calling "Nurse!?" when she had to go, she stood herself up out of the wheelchair and peed on the waiting room chair; and got back in the wheelchair.
I felt bad but that didn't prevent me from laughing. Her person from the assisted living facility brought a change of clothes.
Wednesday, April 15, 2009
When a young colleague dies for no apparent reason in your own ER it just makes no sense. Everyone is a mess. One nurse can't stop thinking about it, and talks incessantly about how awful it is; but we're all thinking the same thing. When things get quiet and we're alone with our thoughts, one of us will start in. "I just can't believe it", someone will say, or "You know, she...", and share some awful aspect of the whole scenario.
I know. I just can't talk about it anymore
Each time you run into someone new, it's like ripping open a wound. The details are hashed over and over. The circumstances of her death. The funeral. How awful it is that a great nurse and mother of two is gone with barely a life lived; so much that she wanted to do with her life that will now never happen.
This is a religious hospital which has done.........nothing for it's guilt-ridden grieving employees.
Yet, life must go on, doesn't it, no matter how difficult it seems. Those girls who had to perform CPR and post-mortem care on a friend, how do you think they are functioning Mr. Hospital Administrator? They had to get up the next day and go to work just like every day after cleaning her blood off a back board, bagging her cut-off clothes and stuffing 3 miles of EKG rhythm strips into a trash bag. Yet, it was a weekend and we did not have the opportunity to have a Critical Incident Stress Debriefing (CISD) from individuals who are trained to help workers deal with the aftermath of a traumatic event. We weren't offered a hospital chaplain or even a social worker. What did the hospital do for us?
Nurses, xray and lab techs from downtown volunteered to work so that all who wished could attend the funeral. One of our nurses sang a song, a beautiful tribute. EMS sent out a "last call" over the radio, honoring her 14 years of service to the local ambulance service; they had the chilling duty to respond to her house for a cardiac arrest. As he left the cemetery, her 3 year old broke my heart as he waved goodbye to his mother's casket.
Nearly two weeks.....two weeks... later we are offered a debriefing or sorts; it is too little too late in my opinion. Please spare me the religiosity; 31 year old healthy females don't belong "in Jesus' arms, resting and relaxing" when they have young children and a whole life ahead of them.
You bet I'm angry. My attitude sucks and I have referred to so many of the dental paineurs and narcotic seekers as douche bags that my co-workers are getting tired of it. Rightfully so.
The hospital clearly doesn't give a fat rat's ass about us or our loss; if or how we deal with it. We are outof sight and out of mind. Our co-worker is buried in the cemetery next to our facility that most of us drive by each and every day. She will be there forever, and we are constantly reminded of that fact.
As nurses we are used to dealing with grieving families, but are at a loss to come to grips with this tragedy. Time will heal of course, and we soldier on for now. We will help each other through this crisis because apparently all we have is each other.
Thursday, April 2, 2009
So, what am I doing on my week off? I'm glad you asked. I spent two days sitting in a class taking TNCC (Trauma Nursing Core Curriculum). This is a course that I have taken 3 times over the years. It is two days of lecture the various aspects of what trauma does to the human body and sets forth a systematic approach to patient assessment, discusses interventions and procedures that should be anticipated. It is always good to review this kind of information. Normally I am a wreck going into any type of exam situation where I am one-on-one with an examiner with nothing but my wits........which normally shut down. Last time I took this course I gave the examiner my maiden name although A) I don't use it and B) I had been married about 26 years at the time. Just a bit freaked. This time, I approached the course from a different study perspective and I did.........nothing.
Yep. I am so burnt from school I didn't open the book. I sat and listened. When it came time for the practice session yesterday, I thought I did pretty well even though I got the pregnant, domestic violence patient which means that I actually had 2 patients to run through.
Today as the written tests were handed out, we were told that some of us did so well on the practical yesterday that we already passed. I figured I'm never that lucky; I was amazed to learn that I had in fact already passed the practical and was dismissed handing in my written test, which I also passed. Done for 4 years, I'll probably be dead by then. School will kill me.
I hate to keep ranting about school, I promise I will stop after this. Panic has begun since I have set some pretty unrealistic goals for graduating next May. I am taking the Humanities CLEP this week; if I pass I will get credit for 2 courses. That will leave me with algebra, college math, American government, and chemistry to CLEP. I won't have a problem with American Govt., but the other 3, not so much. I don't have tremendously high hopes, but miracles do happen. Right now I have a head full of "isms", architecture I never heard of and trying to embed the circle of 5ths without confusing it with Circles of Hell. Dante's got nothing on me.
Wish me luck!
Tuesday, March 24, 2009
OK, well then. Long story short, the kid needs an enema. Since he is apparently no stranger to this form of treatment (and the pediatric variety have absolutely no effect on him) he gets an adult fleets. Some parents are funny about this, so I asked if mom wanted to do it or me.
She asked the 6 year old who was now sleeping peacefully and comfortably, "the nurse" he mumbled sleepily.
I am organizing my stuff when the 6 year old sits bolt upright, points his finger at me and says,
"DO YOU KNOW MIKE ROWE?? HE DOES 'DIRTY JOBS'!"
I was taken aback, but blurted "Are you suggesting that this is a dirty job?"
"Yeeeeeeeeeeessss", he replied with a grin.
"I've done dirtier jobs in my life, that' for sure. Let's take care of business".
He left feeling much better, not to mention about 8 pounds lighter. I was a little shaken though.
I have been in school to get my BSN for nearly 2 years now, plugging away, enjoying some courses and not enjoying others so much. I put a lot of effort into the work I do because, hey, at
53 the brain cells aren't all firing at once anymore. Some seem to be on permanent holiday and the others just don't want to pick up the slack if you catch my drift. But I digress. Anyway, so far with lots of time put into my studies I have managed to maintain a 4.0 GPA, and I'm pretty proud of that.
This present course has me living, eating, breathing and sleeping Anatomy and Physiology (and lab) nearly every waking moment that I am not at work.
It flat out sucks.
I am no stranger to A& P (and lab); I am a nurse, I have more than a passing aquantaince with the human body, it's various fluids and emissions. I have taken the course twice before with the 2nd and most recent being 35 years ago in my RN diploma program. My school closed its doors forever somewhere around 1980, but the hospital maintains our transcripts. All of the sciences I took then were listed as "correlated sciences" so no credit for you, do not pass go or collect $200.00. Do retake A&P. And whilc you're at it, take A&PII in the spring
I have 4 days left of this course from hell. I am hanging on to a solid B in the lab, and a tenuous A in the lecture course. I am feeling pretty tired of it after 10 weeks, and I am done with it.
My advisor is out of the office so I can't ask her if I have to have this same obnoxious prof. next time around. I may have to kill myself if I do.
It's a good thing that the job is going well or I would be downright certifiable.
I just keep telling myself it's almost over, it's almost over. At least the winter passed with hardly any notice at all. Wasn't Christmas last week?
Thursday, March 5, 2009
Having spent a number of years "moonlighting" as a school nurse, I know a thing or two about head lice. Nothing would strike fear into the hearts of parents and teachers like a rumor of head lice. Now, I refused to do scheduled head checks on a school of 500+ Kindergarteners and 3-5th graders. Some school nurses did, but WTF, I was the boss and my principal was fine with it; I had a "no nits" policy which worked well. In 9 years, I had no epidemics. A few cases of course, but my system of finding out who the friends were and targeting their classrooms for headchecks worked like a charm. Most of the teachers asked me to check them as well although I never, ever found so much as a spec of dust that LOOKED like a nit. I did have some fun with one or two of my teacher friends over the years by sharply and audibly drawing a breath and muttering "uh-oh". Psych!
My friend Rita the school secretary was a great one for practical jokes, as was I. We once took a picture of a popular grade 4 teacher and put in on a milk carton after he was late back to school with his class on a field trip. The kindergarteners did a fun little graduation program each year (it was always the same) that featured a song that goes "P-u-r-p-l-e, purple, purple" and sung to the tune "Camp Town Ladies". I had a giant blowup purple crayon that I marched back and forth so that only the teacher could see; cracked her up, especially the year I did it with a giant pair of sunglasses and a wizard hat. Being a school nurse would probably have been a better choice to finish up my nursing career, but I had to let it go; I loved the kids and teachers, but the parents were all nuts.
One year I decided to have some fun with the head lice letter I sent out:
Memo to: Parents
From: EDNurseasuaras, School Health Nurse
Prepare to be horrified.
OK, I won't beat around the bush: there are headlice in your child's class
Now that you've stopped screaming, you should know that there is no need to panic. Really.
Seriously. DON’T PANIC. It is a common occurrence. Head lice are very small critters that attach themselves to your child’s scalp. They bite the skin and suck blood. The bites are itchy; that is what tipped off your child’s teacher, the continuous scratching. By the way, Mrs. Jones won’t be in tomorrow; she will be taking a personal day.
Head lice lay eggs, which adhere to the hair shaft and are pearly gray in color; They may look like dandruff. If you can easily remove something that looks like dandruff, it is not head lice. If it has attached itself to the hairshaft and has no intention of moving on...yep, it's headlice.
Lice spread from person to person. Infestation may occur as a result shared hair brushes or hats; sometimes it's a love attraction. Also they jump really far.
Head lice will take over the next two days of your life if you are committed to eradicating them. Remember, cockroaches and head lice are all that will survive a nuclear holocaust, so unless you are prepared to use lethal force they will become a permanent fixture. Don't say I didn't warn you.
You will need to boil the brushes, put everything that won't melt into the dryer, vacuum anything too big to go into the dryer or put it in the garage with the stuffed animals for the next 30 days. I am not talking about your child. And we haven't even gotten to declaring chemical warfare on the critters. Hopefully yours won't have become immune to Rid yet. Be sure to spend about 4 hours combing your child's head with a fine tooth comb. I will be checkng your work, so be thorough. We want your child in school, but without his/her little friends.
If all of these methods fails there is always Raid... or shaving the head.
That’s all about headlice.
Friday, February 27, 2009
"Hi, I'd like to come down and get the equipment to draw my mother's blood. She has Alzheimers. I have the paper from the doctor saying what tests she needs so you could look at it and tell me which tubes I need".
Phone call from a pharmacist 30 miles away:
"We just wanted to check and see if Dr. R. wrote over the Vicodin prescription. Also, the dosing was a little odd, it says to be taken three times a day".
nope. The doc didn't do it, the patient did. Overwrote "valium 5 mg" and changed it to vicodin 5/500. Local constabulary dispatched to perpetrators residence. NO SOUP FOR YOU.
2nd phone call from a pharmacist, this time local:
" Hey, just wanted to check and see if Dr. P. knew that (anonymous, for HIPPA reasons unless I made the whole thing up) just picked up a 'script for 30 Vicodin from Dr. N when he dropped off the one you wrote for him for 20 Vicodin."
hmmm. Nope, he didn't say he saw his doc today, must have slipped his mind. You can rip that one up and the patient and doc will have a little chat about the importance of being honest with your provider.
Woman complains of painful intercourse x weeks. Has no insurance so comes to the ER, where her care is virtually free courtesy of those of us who pay for her to have this privilege. Has an ultrasound, but doesn't want to wait around for it to be read by the radiologist. Husband certainly has time to ask for a script for narcotics though.
Pedi severe head trauma from last month doing well and headed to rehab.
Sign on closet of one of the nursing units:
Student Nurse Closet
in small handwritten letters just below above sign
"Occupancy 13 student nurses".
Told you it was random.
Monday, February 16, 2009
He had quite a pronounced Scottish burr. And was quite delightful.
He was wearing well worn jeans and a really nice pair of Nike shoes, and began quietly and continously singing "Home on the Range" in a lovely sweet (mostly) in tune tenor voice. Over and over and over.
I wanted him to sing "Loch Lomond", but the Brit paramedic reminded me that it is a song about death, so it probably wasn't such a good idea. I didn't mind, really. He was singing pretty quietly as I said and minding his own.
The doc stuck some adrenaline up his nose with a piece of cotton and went about his business, only to come back and find the cotton...gone. He gestured frantically; "I need you to babysit him, I don't know where the cotton is"
"Do you think he swallowed it, aspirated it, or pocketed it?" I asked unhelpfully.
"Dunno. Can you just squeeze his nose for 10 minutes?"
Squeezing his nose for 10 minutes was no hardship for me, but it did keep him from singing "Home on the Range". He had switched to "Let Me Call You Sweetheart".
The gentleman calmly allowed me to squeeze. Every so often he would say (I thought), "I've been a carny all my life". As in carnival, perhaps.
Well. "So what kind of work did you do there?".
"Oh, cars, all sorts of engines".
What I realized was that he had been a mechanic all his life.
The doc comes back after 20 minutes or so, finishes up and my little man was ready for his ambulance ride back to the Alzheimers warehouse. I was sorry to see him go, although he did start to wander around a bit and was fascinated by the blanket warmer in his room.
Oh, and I found the missing piece of cotton on top of the thermostat.
"Home, home on the range....."
Sunday, February 1, 2009
Um, for the record I didn't ask. And I don't care, especially since you continue to refer to your son as "princess". One more admonishment for him to "man up" (he was) and I'll give you something to man up about. This was clearly not a very deep gene pool as I was to learn.
Mom returned from the bathroom and announced, "Hey, there's Calgon soap in the bathroom, isn't it supposed to take you away?"
Husband: "Why, isn't that an Italian sandwhich with cheese and sauce?"
Me: "No, that's a CALZONE" ("you moron", my thought bubble screamed)
Husband: "Well, I was in the same state, the both start with 'K', don't they?"
I had to leave the room.
After an xray (negative) I cleaned up the cuts, put on some antibiotic ointment, assured the mom that her son would be able to play baseball and sent them on their way. But not until the brain trust that was dad asked if he would get crutches.
"Um, for a hand injury?"
"No, I just wanted to have them around in case we needed them".
Tuesday, January 20, 2009
Can I say "fuck" on this blog? Guess I'll find out.
Perhaps in the ER we should institute an "F Scale".
I see this as an adjunct to quantifying pain via the pain scale.
Let's say a patient is complaining of back pain. He might say something like "Ah, FUCK. My fucking back hurts so fucking much, I just want to fucking kill myself. FUCK!
So, the pain is 10/10, with an F scale of 5. And a +1 for suicidal ideation as a bonus.
Another way to guage the turkey factor is F per minute.
This is just overkill. And insincere. I heard you the first 9 times you said it.
I used to work with a very funny doc. He was really an angry young man deep down, but pretty funny usually. In my opinion he had the best possible use of the F word. He frequently used used the expression: FYYFF.
Fuck You, You Fucking Fuck. Or more accurately:
Fuck YOU. You. Fucking. FUCK.
The last 3 words were sort of slow and enunciated, like 'You. dirty. rat".
I really appreciate the f bombardiers who pause after a string of f's to ask me how my shift is going. Ah, trying to endear yourself to me are you? Won't work, I can see ya coming a mile away.
My boss hung up an article written by someone whose defense against busy or compassion-lacking nurses was to get "up close and personal" with them, to try to connect with them in some way as to increase the human factor. One of her tactics was to ask if the nurse had children, or comment "I love your clogs!". Seasoned and hard core nurses won't fall for this; it just signals them that there is an agenda. It did get me thinking though. Anyone of us would advocate strenuously for a loved one, it just happens that those of us who work in health care (especially the ER) are usually more direct.
Hey Doc, great clogs!
Sunday, January 11, 2009
As an aging BSN student I continue to plod along one course at a time. I can't say I actually enjoy it, but at least now I am over the hump and have more credits under my belt than the ones to come. I am CLEPping humanities next week so I can get credit for two electives, and plan to CLEP American government, college math, algebra, and chemistry. These latter three are not strong suits and will require tutoring probably. Although I did discover a web site, Aleks, which is sort of an online tutor for math and science. I have done a few math modules and have discovered that I'm not as math-illiterate as I have thought all these years. I found out that there are (gasp!) RULES for this stuff! Imagine that! I just never picked up on that in high school! Ha!
On the work front I have stopped doing the admission job. It was too stressful for a lot of reasons. Now, keep in mind that I have plenty of supervisory experience. I was a clinical leader in a very busy 35 bed ER, was a nurse coordinator for a bunch of school nurses, and I have been a charge nurse for most of my 32 years. Heck, my first job out of nursing school was a 3-11 charge nurse on a 40 bed rehab floor. Just me and my shiny new RN license, 1 LPN, and 4 LNA's. Talk about home alone! The point is I can handle pressure, but I digress; the admissions job was like fitting square pegs in round holes. Nobody wanted to take the admissions, the PACU needed to get people out, the ICU needed to get people out, the ER needed to get people out, Tele needed to transfer non-tele's off their unit, the floors were understaffed and overwhelmed, primary docs wanted patients directly admitted and it was pretty much a damned house of cards on most days because beds were scarce as hen's teeth.
So what have I been doing instead? I took a position at Scary Catholic Hospital where nobody yells at me. Yeah, I took a pay hit. Yeah, I have to work weekends and holidays. But it is a relatively stress-free existence. I will still work in the ER at Pseudocity, but I won't be doing much in the admissions line. I am rather liking my sanity.