Thursday, November 29, 2012

Whineurs

Some days people do nothing but whine.  I'm not talking about my co-workers.

1.  36 year old with ankle injury 5 hours before.  He wrapped it in an ace bandage, put his boot back on and continued to work for 4 more hours.  He had 11/10 pain which was unrelieved with a Percocet his brother in law had conveniently provided about an hour before.  I was hard pressed to find even minimal swelling.  Who goes straight from ace wrap to Percocet?  This guy who whined, body whined, whistled like we were pulling his eyebrows out with pliers and made a spectacle of himself.  On discharge he refused crutches because he had some at home, applied his own aircast for his non-fracture, and disputed the very generous prescription for Percocet 5/325 because "I just took the 30 mg and it didn't even work".  Get the fu*k out.

2.  50 year old male with back pain.  Oh and chest pain.  The back pain is 10/10 and consumed his total attention.  He also whined and body whined, and curled himself into a fetal position with ease while I tried to get an EKG.  He stated he was seen at Pseudocity ER last night for the back injury (he fell at work) and was only given Tylenol.  He gave up to the ER doc that he was taking percocet only because we were sending for his last ER record.

3.  32 year old male with testicular pain from a back injury.  He said it was a work injury.  This was his 2nd visit in 2 days.  He would not take his coat off, but Partner in Crime insisted that she needed to take his BP. He held his arm in a very specific way so that the underside was not in view.   The ER doc insisted that he get into a gown.  That was when he found the needle marks that he said was "caused by someone else doing it to him".  The girlfriend hung her head.

4.  38 year old female with cough and cold.  This qualified as Man-Cold.  "My friend says there has been a lot of flu around".  Yeah, in the next state.  She too whined and body whined and was pissed that we didn't have any Tamiflu to give her.

I expect men to be whiny, but woman, you pushed two pumpkin-sized offspring out of an opening the size of a silver dollar.  Please, please, please suck it up and be an example to these men.  You have set the women's movement back 50 years.

Wednesday, October 31, 2012

On Halloween...

For safety Halloween was, by decree, delayed for a couple of days, which was kind of too bad because the sky looked pretty spooky right about sunset. 
We were very lucky in this area. No flooding, minimal power loss for my street, not a lot of wind damage.  We only lost power for about 6 hours which was surprising since normally we lose power for days at a time.  With so much devastation along the East Coast we were very fortunate indeed.  I can't imagine how awful it must be for many communities, and how awful it is going to be for quite some time.  Here's hoping that all emergency workers stay safe.  

I'm over Halloween though.  I haven't had a single kid come to my door for the past 7 Halloweens living here north of the Arctic Circle.  I live on a cul-de-sac;  there aren't any school-age kids or street lights, and the houses are a good couple of acres apart and set far back from the street.  Even if we were one of those neighborhoods that attracted the sort of mini-van drive-by street-cruising Trick-or-Treat ninja mamas, they would still have to drive from house to house.  It's apparently not worth the effort or gas for a paltry candy haul.  As for me, I usually try to work on Halloween, but failing that Mr. EDNurseasauras I will go out for the evening.  It's the best time to go out because there aren't many kids or crowds in the restaurants, and we aren't out late enough to have to deal with the bar crowd.  It's also the best plan to avoid having my dog go ape-shit with the doorbell and having all that leftover candy around calling my name.  OK, so I'm a Halloween Grinch.  

And shoot me if I've never liked costume parties.  There's just too much pressure.

Here is a Costume Fail I came across at a flea-market last weekend.  
What the quack??

My dog had a better costume wearing her hunting season walking attire.

"Where is my beret?"

Even at work I never dress up.  I once wore my cap, but I don't have seasonal scrubs with cute little ghosts or witches.  I have nothing against them, it's just personal preference.  I'm more comfortable in boring scrubs.

Partner in Crime does all the decorating and acquired this little craft-fair felt sign to hang up at work.
Me: "It says HAPS-PY"
PIC: "No, it says HAPPY"
Me: "Clearly, there's an S in there"
PIC: "That's part of the pumpkin vine, see there's leaves on the stem"
Me: "Why would it be carved up with a face if it was still on the vine?"

Argument for argument's sake.




So...Hapspy Halloween, even if the police chief says no Trick-or-Treating until Friday.  Stay safe.

Saturday, October 20, 2012

We Are Going to Need Some New Monkeys

This is a picture of a fenestrated drape.  It is sterile and, among other things, comes in a suture set.  It is made out of a kind of heavy paper towel type of material.  


The whole thing is sterile and kind of extends a sterile field.  If placed over say, a laceration that has been prepped and anesthetized, the laceration would poke through the middle.  This ensures that the suture material doesn't become contaminated by anything.  They are generally supplied by a manufacturer.  See that nice, neat, carefully centered hole in the middle?

Note that I said "middle".  Now, see this?



The hospital has been trying to save money by using making their own fenestrated drapes.  Clearly there are some employees unclear on the definition of "middle".

"Send this down to central supply with a note for the manager", said Gil.  "This is the 3rd one of these I have gotten today, that is so annoying".

To: Central Supply
Re: Fenestrated Drape
Houston, we have a problem.....

Friday, October 19, 2012

Cat and Mouse 2.0

Note: No mice have been hurt in the writing of this post

Our daytime secretary happened upon the newly placed mouse trap provided by the facilities people (not IT) and found...shriek!...A MOUSE.  She hyperventilated for awhile, then came up with an action plan.  Leslie picked up the trap wearing two pairs of gloves and stepped out the ambulance bay door into the shrubbery adjacent to the ER all the while saying Ew!  Ew!  Ew!  Ew!  While she felt a bit squeamish about rodent rescue, especially before she had her coffee, she didn't want it dead or suffering.  At first, she gingerly shook the trap to dislodge the mouse off the sticky stuff at the bottom of the trap.  When that didn't work, she shook a bit more vigorously.  Finally she managed to get the lid off and tossed the live mouse into the brush; Leslie was shrieking, the mouse fairly silent as it ran off into the woods probably to warn the rest of his mousey friends.  Traumatized, Leslie made herself a cup of coffee and sat down with a bagel.  I don't know about the traumatized mouse.  It has been at least 3 weeks since the traps were placed, now long forgotten by facilities.  These traps are apparently going to be there forever.  Naturally we have had a little bit of fun with them.



Helpful hints


No mice have been even remotely attracted to this.  
























Thursday, October 18, 2012

Meet Pull-Toy

I have another student.  Yes, the powers-that-be have given me another young mind to mold and shape as I desire (insert evil laugh).  Bless her little heart.  It is pretty much a 2 month job shadow, but I can probably at least get her to change beds and fill ice packs.  Fun.

Last time I had a high school intern for more than a day she spent about 6 weeks mostly doing her homework; rather, she doing hers and me doing mine.  On her second to last night I gave her a syringe and a couple of 10ml vials of normal saline and taught her how to draw it up and remove the bubbles, etc.  She wore out the syringe doing it over and over and over; it kept her busy for about 2 hours.

Her final critique of the experience: "EDNurseasauras taught me how to put water in a syringe with a needle and take out the bubbles.  It was the best thing".  She had a whole little presentation on it.  I am famous at the high school.

Sigh.  (sniff).  They grow up so fast.

My new little pull-toy hasn't decided on nursing or medicine or what the hell-all she wants to do, which is great.  Her mind is like a fresh batch of cotton candy.

Pull-Toy wants to see and do it all and have lots of experiences.  I reminded her to journal and pick out the best and worst stuff of every night mostly because I thought I should be able to give someone some homework for a change; yeah I know, power trip.  Actually it would make her life easier when she has to do a presentation at the end of the year for her class.

Most of the doc's are pretty good with students, and when it isn't really busy will let them watch suturing and stuff.  I thought I would start Pull-Toy off with watching me apply a finger splint and went off to the closet to fetch it.  When I came back, Mac was quizzing Pull-Toy about which joint she thought would be proximal and which one distal.  I sent her off to look for tape instead.

Me: "Mac, maybe we should teach her the bones first before we worry about joints"
Mac: "Oh, yeah sure, wouldn't you learn that in nursing school before you start clinical exposure?"
Me: "Yeah, probably, but she doesn't graduate until June"
Mac: (astonished) "Eight months or so from graduation and she hasn't finished anatomy?? How can that be?"
Me: "Um, well she's a high school student"
Mac: "Ohhhhhhhh.  Ok.  That's cool"






Wednesday, October 17, 2012

Dewshe Bagghe of the NIght

In the middle of an absolute shitstorm  I became aware of the smell of....smoke.  Electrical?  Burnt popcorn in the microwave?  Wednesday thinking too hard?

No.  It's...cigarette smoke.

Where is it coming from?

Cardiac guy just sparked one in the bathroom.  While waiting for his telemetry bed downtown, his 3rd admission in a month.

Really?

Mac confronted the guy; tells him that his decision to light up in the unventilated bathroom was a selfish decision which has made the  environment toxic for patients and staff.

I was furious.  It is one thing if you have a death wish and want to poison your own body, have at it.  But please.  In a hospital, dude?  You could have gone outside which was a lot closer than the bathroom.

Mac: "He said he was sorry"
Me: "He can stick his sorries in a sack.  What a douche"

Smokey: "Hey!  Can I get some more of that dilaudid before I go in the ambulance?"

Dear facilities, I would like to request that a smoke detector be placed in the bathroom.....

Tuesday, October 16, 2012

A Sarcastic (no sh*t!) Open Letter


Dear Parent,
We are happy to provide you and your child with care today.  If there is anything we can do to make your visit extra-special or answer any questions, please ask any of us; we work as a team and automatically know the intimate details of your history, allergies, medications, and exactly how long the wait will be.  Feel free to ask our secretary and radiology tech also because they all have instantaneous access to this information as well as everything you have told the 3 nurses who have taken care of you today.  They are not at all inconvenienced by your requests for extra blankets and pillows, pain medicine, hovering at the nurses station or in the doorway in spite of having been given a call button and closing your door.  Patient privacy apparently just means YOUR privacy, so think nothing of it.

I know you are concerned about your son.  It is just awful that he stepped on a nail while wearing his tennis shoe, but forgive me if I need a little guidance in finding the puncture wound.  No, it neither appears red nor swollen to me as I have scrubbed it twice with antiseptic solution.

I do apologize for the 2 1/2 hour wait today, as you can see every room is filled.  I am reasonably sure that your son will not get "blood poisoning".  Thankfully you have kept such an eagle eye on it checking and updating us every 10 minutes about your observations, any trifling concerning redness and elevating it on the three pillows.  I can't say for certain, because I am just a stupid nurse, but I can tell you with some assurance that at the moment he does not have flesh eating disease.  Yes, I would bet my children on that.

I am happy to provide you with 6 warm blankets; no, I don't mind at all that you have used them all for your healthy 12 year old and that my 80 year old patient next door is now cold and without.  Not a problem; I have given her my fleece jacket, so it's all good.

Of course I think it is reasonable to wheel your son back and forth by wheelchair to the bathroom and to the snack machine in the lobby, after all, who knows what damage he may have done walking around (and from the parking lot) in the 3 hours since he injured himself; I'm sure it wasn't easy walking around at the high school football game.  It is absolutely not a problem that you prefer he be taken to xray that you insisted on by gurney because "he would be more comfortable";  I don't know how I could be so dense as to suggest that he could go by the wheelchair you have commandeered this afternoon for your son's exclusive use.  Perhaps I could now put the gentleman with cellulitis in it.

I am so heartened by your devotion, steadfastly sitting by his bedside and stroking his hair the entire time, it made the chunks rise up brought tears to my eyes. The only time you left was to make one of 20 phone calls and to smoke a cigarette or 10 during your wait.

Of course we will provide you with your son's first dose of antibiotic that you also insisted upon.  I understand how inconvenient it is that we don't have chewable tablets.  Yes, a lot of 9 year olds can swallow pills and some 12 year olds can't.  No, he shouldn't chew a capsule, I'm sorry that is all I have in that antibiotic.   I don't have "any chocolate chip ice cream lying around" and available for him to try and slide the capsule down.  I know that the pharmacy is open for another hour, but  of course it is reasonable for me to delay the EKG on the 65 year old woman with chest pain and send the hysterical mom with the 14 month old febrile seizure to the waiting room while I call that in for you.  It will "just take a minute".

Here are your discharge instructions.  A dressing will consist of a band aid.  Change it every day.  Watch for signs of infection.  Post-op shoe for comfort.  Wear it as long as you want.  Call your doctor tomorrow for recheck.  Antibiotic as written.  I promise I will not leave this room until you understand each and every word.  Really, I have time.

I completely understand that the post-op shoe is ugly but that is the only style it comes in: "ugly", small, medium and large.  The doctor sincerely believes that Tylenol with codeine is not appropriate for this injury, but here is one for you to take with you for tonight "just in case".

Finally, I think I would have just let him walk on the post-op shoe since it didn't really hurt, but if you want to get a hernia giving your 12 year old a piggy back, be my guest.

Until next time,
EDNurseasauras

Monday, October 15, 2012

It's the Grinchiest Time of the Year

That Christmas items are out in stores before the pumpkins are even carved bugs the crap out of me.  Partner in Crime is a great one for decorating and will take down Easter posters and fuzzy bunnies that very night, etc, in order to get ready for Cinco de Mayo or whatever.  That's fine, I have never been one for overly enthusiastic decorating.  When I was a school nurse I had no trouble getting the 5th Grade Asthmatic Society girls to pull something out for my bulletin board, pretty much a school joke.  Teachers may live for that stuff but I hated to do it.  I could come up with a theme, but had absolutely no clue as to how to accomplish my vision.  The Girls hated to be outside on cold days, so it was a good deal for everyone.  It got a little rowdy when once I had 15 girls and their friends cutting stuff out of poster board and colorful construction paper, but damn if that bulletin board didn't look the bomb when they were through.

Which, in a round about way, brings to the subject of today's rant.  The Christmas Basket project.

You may recall that last December I went a little off the rails with the whole Christmas for Entitled Douchebags project.  This time I have hijacked the entire community gift giving thing and established rules.  My co-workers who are not terribly verbal have elected me spokesperson; my first order of business was to inform Beth that we were making some changes in the Christmas gift giving policy.

1.  No families, no teenagers, no brand names, and no electronics (unless it is an alarm clock).
Last years families requested things like IPods and Lucky Jeans, Ugg Boots and IPads.
There will be no repeat of this fiasco; perhaps people will then be free to focus on NEEDS.  Nobody needs Ugg boots.  I will cheerfully buy snow boots and mittens for kids, but that kind of greedy crap just did not fly with me.

2.  No makings for Christmas dinner; but gift certificates for the local market as well as for gasoline would be welcome.

Beth fought me on this one, but I prevailed
The ridiculous amount of "stuff" that was collected for the families to make one meal, their own Christmas dinner was just way, way overboard.  Included were things like potatoes, stuffing mix, canned gravy, turkeys (free from the hospital) and other fixin's; pie fillings, boxes of brownie mix, bags of walnuts, bags of chocolate chips, butter, flour, sugar and baking powder, etc.  There was just no way in hell any of these families needed any more sugar if we were buying xxxx and xx sizes for teenage boys and size 22 for a teenage girl and her mother.  One of the recipients was a diabetic.  Aren't we supposed to promote healthy eating?  The turkey was probably the healthiest item in the box, and each of the 3 families got two boxes.

3.  We are going to focus on two things: a couple of individuals in need, and the local food bank.
We will address any needs first; any leftover funds would be given, either by check or purchase of food, to the food bank in our town so people in our area could be better served.

4.  Any staff member is free to elect an individual or couple (or, ok, a family with small children) for the gift giving project.  We have charged Sherry with that task, which she has agreed to.  She is in the best position to do this as she also does a lot of community stuff.  In the event we receive more than a total of 4 people the final choice would be decided on as a group.

5.  The doctors are always generous and not only give us donations for the Christmas Basket, but give all the ER employees a cash gift.  This is such a wonderful gesture that is really appreciated by all.  Some of the nurses actually take that gift and donate it.  I would happily do that, but why not cut out the middleman?  We in turn gave a donation to Wounded Warriors in the name of the physician group instead of giving them something silly like personalized coasters.  This was very well received, and something I would like to repeat.  

6.  I proposed Christmas in October, but that didn't go over well.  Maybe next year.

Sunday, October 14, 2012

Just Doing my Job

My colleague Madness has a post up about the seasonal influx of patients with nausea, vomiting and diarrhea that are lining up in the ER.  She offers some (partially) tongue-in-cheek helpful hints for patients who aren't really sick enough to be in the ER.   Blame lack of common sense, blame a need for instant gratification or a magic bullet, blame lack of knowledge, but Madness is right on point:  patients with viral illness / vomiting, regardless of severity, do clog up the system.

However, one of her commenters took the pissy road.  He/she (anonymous, of course) snidely suggested that if ER's didn't want to be bothered with people who lacked the medical training to determine if they were sick enough to go to the ER, well then maybe hospitals should go on an information campaign to educate the public before they do something galactically stupid like go to the ER for frivolous reasons.

Excuse me.  Hahahahahahahahahah!  Haha!  HAAAAAAAAHAHAHAHAHAHAHAHA! (pauses to wipe tear from eye) HA!  HAHAHAHAHAHAHAHAHAHAH!!!!!!!!

That's rich.  Can you imagine any hospital endorsing that idea?  I can just see administrators foaming at the mouth on that one.  Public service announcements telling people NOT to go to the ER would be shooting themselves in the foot don't you think?

No, the responsibility for that task does not lie with hospitals, the ER, or ER nurses, at least not until people actually come in.  It would never work anyway, for several reasons:

1.  "I have been sick for 10 minutes" You  may be able to educate the stupid, but there is no cure for it.  Individuals who lack common sense are never going to be willing to do anything other than run straight to the ER at the first sign of a sniffle, so, vomiting?  Really?

2.  "My doctor told me to come" Many times patients do indeed do the right thing and phone their doctor for some advice about when they should worry. This is not unreasonable but they mostly talk to an office manager or triage nurse who then tells the patient go to the ER.  The office doesn't want vomiting people and there is a certain amount of liability telling people "it's a virus, you will get better".  This is enormously frustrating for people who, after enduring unnecessary labs, IV fluids, and hours of their lives are told, "it's a virus, you will get better".

3.  "Dr. Google told me to come".  People have access to all kinds of information online, watch way too much Dr. Oz,  and will often show up having already made their own diagnosis.  Information is not a bad thing, but when people come in with their treatment plan and choice of antibiotics already in place based on their research it can get ugly.  See, the problem is that we just don't see that much bubonic plague anymore.

4.  "YOU told me to come".  What I actually said was, "I cannot give any advice over the phone, if you feel like you need to be seen in the ER, we will see you".  For liability reasons,  I am obligated to end every single phone call to the ER for free advice in this manner.  Unless you are having crushing chest pain, then I might go off script and tell you if you were my family member I'd call an ambulance.  I understand that people want some guidance, but sorry, I'm just not allowed to give you any advice and every call ends up with the caller being frustrated and taking me away from the patient in front of me.

5.   "I am sick.  I'm never sick."People have their own individual perception of what constitutes an emergency.  Feeling crappy or scared, regardless of how minor a problem it seems to ER staff in the grand scheme of things is often a big deal to the patients.  People who are rarely ill can be frightened by vomiting.  As ER nurses we just don't get excited about some things, and remember, you may feel quite ill but you are probably not my sickest patient right now.  Perspective goes both ways.  It is important to note here, though, that being a drama queen about it does not endear you to my heart.  I can only reiterate Madness' wise words: "Man up".

6.  "I'm not dead yet".   Conversely, trying to educate people when and when not to go to the ER for their symptoms will not help someone who is insistent on going to work and spreading their germs around to others.  Some tough it out beyond their ability to cope.  These are very stoic people and people in New England who will simply stay away getting increasingly ill and dehydrated until it is late in the game.  Now not only are they really sick, but because they didn't lay low initially have infected dozens of others.  You can't change that mindset, it's useless to even attempt  doing so.

Please remember, people, we are speaking from a perspective of volume.  ER's are busy places, and are inundated with so many that don't really need to be there, as Madness pointed out.   Neither Madness nor I are referring to people who are genuinely ill, who are truly dehydrated and are physiologically unable to cope with their illness; the very young, the very old, the very compromised.  When people come into the ER and ask for change for the vending machine, well, maybe you can see why we are just a little frustrated at times.

Saturday, October 13, 2012

Milestone

My Dad has been gone for 29 years.  On what would have been his 83rd birthday I realized that in the last year I passed a sad milestone; at age 57 I have lived more than half of my life without him.  As the oldest of five,  I was the last to hit this milestone.   
  
Dad only saw his two oldest get married.  Mine were the only two of his 12 grandchildren he ever met.  My ten nieces and nephews will only ever know Dad through our stories.

I've never been back to his gravesite in all these years.  It's not that I don't care, but I was never one for that kind of thing.  But I think about Dad a lot, especially when we are together as a family,  times he would have really enjoyed.  He had a great sense of humor and loved to laugh.  I wonder what books he would be reading now, what he would think about this presidential election;  what he would think about me as a person; if he ever would have forgiven me for those awful teen years.

Dad would have appreciated some of my ER tales having learned an awful lot as a medic in Korea.  He was a pharmacist who worked many years in a small neighborhood pharmacy back when it was called a "drug store" and he a "druggist".  He knew his patients well, and they loved him.  Everyone did.  He was the only genuine "people person" I have ever met.  I would love to know what he would have thought about the entitled a**holes, the chronic abusers of the system, the narcotic entrepreneurs that would now occupy his neighborhood if his little drug store wasn't now a real estate office.

I hope he would be proud of the adults his kids have become and the kinds of kids we have raised.  I know he would have loved to see those grandkids' school plays, learn to ride bikes, play sports, graduate, and become adults as much as he enjoyed those events as we kids grew up.

My brothers and I are lucky that our mom, at 80, is in good health and independent.  She has a more active social life than I do.  It wasn't easy for her though, having to go to work full time in her middle years just when the youngest of their children was ready to leave the house.  I know Mom misses him a lot.  She never got the chance for that "re-do" that I enjoy now, when the kids are on their own and it is just two people again.  The final sad milestone will be when, in a few months, my mom will have been without Dad longer than she was married to him.

Two of us have lived longer on this planet than Dad did although we don't talk about this, my brothers and I.  I'm sure we have all thought about it;  I was a little freaked the year I turned 54.   It's not that we don't talk about Dad, we do all the time.  We just don't talk about that particular hurdle.  We will never know exactly what caused Dad's sudden death, but I can assume that driving to work, turning off the car and simply ceasing to exist was not something that even remotely crossed his mind that day.  I can't speak for my brothers, but I try to mitigate the risk factors as much as I can.  We all live pretty active lifestyles perhaps keeping that fact in mind.  We were all athletes, and are in relatively good health although some of us might be carrying a few extra pounds.   But there are no guarantees in this life aside from the obvious, that no one gets out alive.

Which is why, I guess, we should enjoy every day above ground.  Happy birthday, Dad.

Friday, October 12, 2012

Pool Coup

Some months ago, Mr. Ednurseasauras an I joined a gym...excuse me, health club.  It is a pretty nice place, it has a good variety of stuff to do so there is no excuse for not going several times a week for classes, games, tennis, or whatever.  I enjoy several different exercise classes, pickleball and walleyball.  Unfortunately, I broke Mr. Ednurseasauras  on his first visit to walleyball; a torn calf muscle that took months to heal.  This is a man who hikes regularly, bikes, played hockey until he was 60, as healthy as  many 20 years younger, you get the picture.  It wasn't even an injury you could specifically blame on walleyball.  I mean, all he did was step forward on it so it could have happened anywhere; including the top of some mountain.  He was gracious about it but I blamed myself for badgering him into it as something we could do together.  Thus endeth any further campaigns on my part to ask him to do anything  but walk the dog.  He can go get hurt on his own time.   Which he does.   He is at present recovering and rehabbing from a patellar tendonitis.

On labor day weekend I had my own injury in an activity I have been doing since I was 10 years old; jumping out of a boat.  I had made a pretty bad job of docking the boat and leaped out to tie it, thus saving Mr. Ednurseasauras' knee; my own hyperextended in an explosion of pain.

 I spent the next several minutes dealing with both the pain and resulting near-syncope.  Mr. Ednurseasauras thought I was having a heart attack or stroke, which scared him very badly.  Long story short, I was fine, but the knee is still wobbly which has taken me out of court sports and exercise classes, and I didn't get to the gym for a month.  Tina doesn't get very long walks up rough terrain because I just don't trust that knee.

So, to do some kind of physical activity I started swimming in the lap pool, which seems to be just dandy for my knee.  I am presently doing 30 minutes of laps, then 30 minutes in the warmer pool vigorously treading water with just arms, or just legs and trying to get a workout out of both.

I lurked around one of the water aerobic classes for seniors to see if it was something I might like to try.  The first class seemed to consist of some ladies in their 70's floating on noodles with life belts and chatting.  Nope, didn't seem like it would be any kind of challenge.

The second class was lead by the same woman.  She had the participants raising their arms above their heads while kicking.  Still no challenge, and I had to leave the pool because one of the older gentlemen was straddling a pink noodle which extended out of the water in front of him so....I just couldn't look at that any longer.

Today the class seemed to be running over-time due to some earlier pool maintenance.  There was a small group of unruly home-schooled kids (the next class was advertised as being for home schoolers) anxious to get into the pool for lessons who were being disruptive.  They were sitting at the edge of the pool kicking and interrupting the flow of the class.  No parents in sight, surprise surprise.  One of the women, tired of kids fuc*ing with her chi yelled, "Hey!    You  have the rest of your life to get into the pool, most of us will be dead soon enough, so knock it off!"

Applause from the pool.  Silence from the crowd.

Wednesday, October 10, 2012

Important Announcement

Attention K Mart shoppers!

The will of the masses has prevailed!  ER gowns are now clown-free.

They are now covered with Pooh.

On a completely unrelated topic....what the hell is up with glow in the dark pull-ups???

That is all.

Please return to your regularly scheduled program.

Monday, October 8, 2012

Just One Click Away from Armageddon

All day long all I hear is:

"Arrrrrrrgghhh!  EDnurseasauras help!  My whole dictation is frozen! What should I do!"

"EDNurseasauras!  How do I figure out how to add to an e-chart if I already closed it?"

"Damn!  That's the 5th time I've entered this order!  It just keeps getting kicked out!  Now what?"


I can usually figure out and fix most computer charting errors, glitches, transfers, work-arounds and fu*k-ups. And it's not because I am a SOOOOOOper User.

Mac: "It's a good thing you're here or our fat would be in the fryer.  How did you get so adept with all these computer issues?"

Me: "I click on every button and tab 'til I either run out, figure it out,  or beat it into submission.  I have absolutely no fear of pushing buttons which is why I would be a really bad choice have on a nuclear submarine"

Mac: "Yeah.  Oops.  There goes Argentina"

Me: "Exactly"

Friday, October 5, 2012

Maybe I Should Patent This...

Many of our chronic dental painters / narcotic entrepreneurs have horrible teeth, no doubt about it.  While their "horrible pain and can't afford a dentist" will probably be treated without suspicion initially, the subsequent 6 or 7 visits a month for 10/10 pain smack of insincerity and scamming behavior.  Most dental pain is treated with antibiotics and pain medication.  The more visits, the less likely it is that percocet will be on the discharge menu.  After a few of these visits, the savvy patient starts adding allergies; first ibuprofen, then tramadol.  Then tylenol, which would then eliminate percocet as a choice.  Clever seekers will say they have no trouble with the oxydocone, but that effectively shoots them in the foot since we never, ever give out plain oxy's in the ER.

When the patient is diagnosed with abcess, sometimes they get IV antibiotics.  Mostly they leave with a script for penicillin and pain meds.  Some doctors will write notations on the script numbering the penicillin "1 of 2".  When only script #2 is presented at the pharmacy (the pain med) this prompts a call from the pharmacist asking what the 1st script was, because the patient can only afford one of them.  Definitely needs antibiotics, they are told; maybe they should buy that instead of cigarettes.  The patient usually just goes away, to try and play us another day.

Why not just combine the antibiotic AND the pain med?  Percocillin!  Everybody is happy!

Thursday, October 4, 2012

Cat and Mouse

Nobody has a sense of humor anymore, especially our IT people.

We are housed in an old building.  There are mice from time to time, tiny little field mice.  I haven't seen any in about 3 years, but one was spotted recently by a patient who got pretty upset about it and made all kinds of stupid demands, said she wasn't paying her bill, etc., etc., etc.

I got right on it.  I sent an internal request for someone to investigate our mouse problem.  Just for laughs, I sent it to IT.  I figured it would be a nice change from dealing with forgotten email passwords and taking turns writing about how wonderful they are on the hospital attaboy board.  I checked the box that said "mouse, wireless" and sent it on over.

Memo exchange follows:

TO: EDNurseasauras
From: IT
RE: Mouse Problem

IT is only responsible for hardware issues, computer programming malfunctions, Help Desk issues, and other system issues related to electronic charting, etc.  Your mouse problem does not fall under IT responsibility.  Please initialize request to facilities.

TO:  IT
From: EDNursesasauras
RE: Mouse Problem

That's ok, I'm more of a do-it-yourselfer.  In the absence of a mouse trouble-shooting tutorial, what kind of cheese would you recommend I initialize?

TO: EDNurseasauras
From: IT
RE: Really, it's not our problem but I suppose peanut butter might work.

TO: IT
From: EDNurseasauras
RE: It is now

If I catch the mouse, should I just disable it? Would there be any point in reinstalling?

TO: EDNurseasauras
From: IT
RE: Really???

Now you're messing with me, aren't you?
Do you even have a mouse problem?

Yep.  Also I know the location of the beige marketing cart.  And Jimmy Hoffa.

Eventually the facilities department set traps.
More on that later.

Wednesday, October 3, 2012

Today's Last Patient of the Night....

....was about 5 years old.  He had a cough, the same cough he has had for about a week and for which he has already seen his primary care on two occasions.  Nothing new about the cough and no new alarming symptoms he was just not Magically Better.

Partner in Crime brought in a child-sized gown for him to change into an mom immediately burst into tears.  Not because she was fearful for her child's health or unable to pay the bill.

"Give him another gown!", she shrieked, "it has clowns on it!  Take it off!"

Ohhhhkay.  I'll take the red nose off, sheesh.

Partner in Crime noted that all the kids' gowns have clowns on them.

Thursday, September 27, 2012

Livin' the Dream

Often I  find it necessary to take two deep breaths and force a cordial expression on my face even when I have just had a vacation.  I am seeing way too many of the same faces again and again for absolutely silly reasons, merrily abusing the system. There are just too many taking the a free ride with their "hurray for me, f*ck you" attitudes.  Yes they have a primary care; they just don't want to be inconvenienced.

One of the free-riders is the wife of a narcotic seeking douche bag who is now living with his mother.   Or in jail or some sh*t.  She has an alliterative, cutesy name so I will just call her Betty Buttz.  Betty comes in to the ER regularly enough for me to know all her information and her kids by name for just stupid reasons at LEAST twice a week.  She can be counted on to come in on Thursday or Friday with nebulous injury or pain and is seeking a work note, AKA "Get Out of Jail Free Card" for the weekend.  She works maybe 8 hours per week at the most at a $1 store.  If she has a medical issue such as sore throat, rash or dental pain (often) she can be counted on for two or three additional visits for changes in antibiotics and additional "Get Out of Jail Free Cards for Condition XX, Not Magically Better".  She also regularly asks for refills for "stress and anxiety" medications.  She doesn't ever get them, but that doesn't prevent Betty from asking.

Betty's birth control poster children are also seen frequently.  They are easily the most klutzy, uncoordinated kids on the planet as mom's answer to every bump, bruise, ache and pain is to squeeze her fat free-care ass into her car and transport the kids to the ER.  I think the school office is wall-papered with her kid's "Get Out of Gym Free" notices.  These kids are obese and could use a little physical education.  Last time one of the kids had a 3 or 4 day old knee boo-boo I refused to give out another pair of  crutches because I know I have personally given out at least 2 sets to everyone in the family.  Unless they are using them to hold up the walls of their double-wide, they can reuse a pair.

As if these bi-and tri-weekly visits didn't suck enough empathy out of me, Betty Buttz has started to accompany Crayzee Cutter Friend as a mouthpiece / advocate for her regular field trips to the ER for her self-inflicted suture-requiring transfer-to-tertiary-care-psych-eval.  Crayzee Cutter Friend's medical history, multiple allergies and psych meds are also well known to me.  Betty Buttz is always helpful during Crayzee Cutter Friend's visits by routinely updating her Facebook status and texting their numerous friends and family who also never accompany her to the ER.

Crayzee Cutter Friend predictably gets a ride by Big Taxi with the Flashy Lights (again) to a complimentary psych evaluation (again) so Betty is pretty much at loose ends for the rest of the night (again).

"Where are the kids today, Betty?" I asked conversationally, like I cared.  Probably off playing in dumpsters and inhaling toxic fumes judging from their usual choice of activities.

"With their father".

"Isn't it nice you have an evening out?", I observed brightly.

Betty took the opportunity, as long as she was there, to get herself checked out in the ER (again).


Wednesday, September 26, 2012

Call a Toe Truck Please

Ms. Toe Fetish was in for her 3rd visit of the week for a toe infection; she had been seen about 5 other times in the past year for problems with every part of her body from the ankles down.  See, she has this thing about messing with her feet, picks at them, cuts skin, monkeys with them in weird ways.  She was all drama and har har about how disgusting it was, and how much it hurt, and how much "trouble" she was going to be in for not following pretty much any of her discharge instructions.
"It hurts really bad, it looks gross.  I can't bear to look at it"

For all her penchant for picking at her peds, I don't think she had washed it since last time she was in the ER, nor had she cleaned and dress it as instructed.  Her foot was filthy, and I mean disgustingly filthy.  I'm talking walk in mud, then step in an oil spill, then run through newly cut grass that smells like seaweed.   How much trouble is it to actually soak you foot in a basin of water?  She had on the same flaky old black nail polish on as well.  Ack.

She was also told to wear actual shoes, which she also did not do. She did, however, have plenty of time to take photos of it and send it to her friends.  Double ack.

"Is it the same doctor?  If it is he's going to yell at me, haha.  I hope it's not the same doctor (who by the way, didn't give her any narcotics).  Oh good, it isn't the same doctor.  Am I going to get a needle?  I'm really scared of needles.  Did I mention that this is really the most pain I've ever had in my life?  If most people say their worst pain is 10/10, then my pain has to be at least a 15 and maybe even 20/10" (also note she had about 6 piercings and 2 full sleeves of tattoos).

Really?  I had a sick baby to transfer so I sat her fat ass in the waiting room along with another lady who "just took Phenergan and it makes me sleepy so I need to have my microscopic laceration seen as soon as possible because I drove myself", which guaranteed that it would be at least 90 minutes, sorry.

When Ms. Toe Fetish was eventually seen (Phenergan lady left in a huff; it doesn't help to cop an attitude with the staff) she had the inevitable injection in her toe.  She went on for some time about that, actually getting up off of her bed of exquisite pain and opening the door to the room so we could hear her predict how painful it was going to be later.  "Yeah, this is really going to hurt later, huh?", "I can almost feel how bad this is going to be when the shot wears off", "This hurt before the shot, it is going to be twice as painful when it wears off I'll bet".

She proceeded to ignore the actual discharge instructions and reinvent them.

"Now, I should come right back if it hurts and to have the dressing changed tomorrow, right?"

Sherry: "Oh, no.  You don't have to come back, there's no need.  Just soak it, wear shoes, put a bandaid on tomorrow and have your own doctor see it.  Remember that soap and water are you friends, please take this complimentary basin home".  Like it says in the instructions that we have so nicely written out for you at a 6th grade reading level.  Sherry always sounds so nice when she gives people the hard truth.


Tuesday, September 25, 2012

Nursing Manglement

Nursing: a career in which the more education one receives, the less likely one is to actually know how to do the job.

I thought when I got my degree I would "get" why nurses in management were such dicks to non-management nurses, the nurses who are on the front lines and caring for patients, the nurses who get dumped on with ever-increasing paper work and bullish*t.

Guess what.  My expensive high quality education has ill-prepared me for insightful revelations into the though processes of management: I don't get it.

There seems to be several types of nursing management that I have had the dubious pleasure to work with:

1.  Did the job for a long time.  Can't do it now, but respects nurses who do; does whatever possible to make  the job run more smoothly.

My most-favorite boss/leadership mentor of all time was my manager in a big ER where I was a clinical leader.  She gave me the best advice ever: listen.  Sometimes it's the only thing you can do.  The second best piece of advice was one she often used, offer "What can I do to help?" She did actual nursing for some portion of almost every day, even if it was only holding a kid long enough for someone to stick an IV in.  This is a nurse who not only had all my respect, but someone whose respect I wanted in return.

2.  Has limited clinical experience. Has lots of education.  Couldn't do the job terribly well and now can't do the job at all.  Ineffective.
At one hospital, some upper management brainiac decided to promote the horrible ICU nurse manager and make her ER nurse manager as well.  Great idea.   All the ICU nurses hated her.  She didn't know a balloon pump from a water balloon.  She never worked a single shift in the ER and had no understanding of how ER nurses work.  Or how our department was run.  In fact that small hospital was the only place she had ever worked from the time she passed her boards.  Miserable human being, she was eventually canned because 10 people quit, including me.

3. RN with an MBA.
If you are going to run with the big dogs, and all that.  Yes, she dealt effectively with upper management so probably didn't spend much time with bullsh*t nursing theory classes, of which I swear I will never take another the rest of my life.  What good is nursing theory when it ill prepares a manager to deal with other managers?  This boss said every day she could not do our job clinically, although she was lavish with praise for jobs well done, as well as a bang-up customer service rep.  However, the only time I ever actually saw her was if there was a problem.  She was great for committees.  Have a suggestion or an idea?  "Great!  Get a committee together and let me know what you come up with!"  Shared governance really just means "let's have a meeting or 10 about that.  Then, management will do whatever they wanted to do anyway".

4.  The hands-on clinical leader vs. the hands-off clinical leader.
This type of boss may or may not have the education.  They are really good at either doing the job OR sitting on his/her ass and delegating.  Being a clinical leader is definitely the type of job that can be characterized as "Lead, Follow, or Get the Hell Out of My Way".  Clinical nurses can tell in about 5 minutes which ones are lazy and which ones support the nurses they work with by actually helping; some examples are supporting their staff by yelling at the floors to take patients, or bullying the nursing supervisors to get off their asses and have THEM yell at the floors to take patients.  They have little tolerance for lazy nurses and just don't put up with nurses who insist on riding the LNA's like My Little Ponies while they put their feet up and update their Facebook status.  My favorites love to put out fires; my least favorites run through the ward screaming "FIRE!" while it just gets hotter and the flames spread.


Sunday, September 23, 2012

The Dreaded

A 25 year old female came in with her husband.  She was 26 weeks pregnant with her first child and had been ill with a viral illness for 3 days.  She had not felt her baby move for 12 hours.  Go directly to the nearest ER if you are too scared to monitor this yourself at home per OB on-call; we are too busy in labor and delivery.

Ah, geeze.  Why do they come to my ER with no ultrasound available at night?  I. Do. NOT. Like. Pregnancy. Related. Stuff.......Seriously, it gives me agita.

"OK.  I am going to listen to your baby's heartbeat.  This is not my best skill because I don't do it all the time, so PLEASE don't be scared if I don't find it right away, mmmm-kay?"

EDNurseasauras goops up the wand, places Doppler on mom's belly and gets......

Beep!  Beep!  Beep!  Beep!  Beep!  I know with absolute certainty that it is neither the mother's pulse nor mine.

"There it is, your baby's heartbeat!", I say with relief.

Mom: "Oh, thank you, thank you, thank you! I was so scared!"

Me too, sweetie.  Me too.

Friday, September 14, 2012

Lunatic Fringe, I Know You're Out There

"Oh, I know her", Ellen whispered as the patient was ushered into a treatment room.  "I think she moved away, I hope she hasn't moved back.  She hasn't been here for YEARS, but she used to come in alllllllll the time for a bunch of things and it always had to do with pain everywhere.  She never shuts up.  And.  She looks awful"

More like 8 miles bad road.

"She is 3 years younger than me!", whispered Partner in Crime.  She was mid-50's and looked 70.  

It was Crayzee Dog Lady, allergic to 17 different meds including oxycontin, nsaids, several different anti-seizure meds, 3 different kinds of band-aids.  I gave up on an allergy bracelet.  Her med list was horrific.  CDL clearly relished her role as Medical Mystery and of course being Chronically Sicker Than Anyone Else on the Planet, having the World's Worst Case of Everything Puzzling Under the Sun.

To make a long story short, she wanted pain meds for her excruciating rib pain.  Seems her Emotional Companion Dog in Training, an enormous 8 month old Doberman over whom she had absolutely no control, had pulled her down.  See, this is the reason why you need to actually TRAIN dogs.

CDL had an x-ray (negative) and moaned and groaned in her room while we waited for records from her latest admission at another hospital.  When she wasn't in an out of her room informing us how sick she was and how much she seems to enjoy talking about herself and her maladies, her own favorite subject and bestest hobby.  She was eventually given a dose of Vicodin with the stipulation that she get a ride home.

"Oh, my friends are on their way from Walmart.  It shouldn't be long"

45 minutes later no sign of the friends.  "There must be a lot of traffic", she said.  Not on Sunday night.

"She's waiting for us to turn our backs so she can scarper out the door", I said.  We are wise to that.

"She probably takes about 1,000 mg of oxy's a day, but we're still liable if she hits someone", said Partner in Crime.

Eventually CDL stated she was going out to the car to let the dog out.  WTF.

"Don't drive", I called as she walked out the door.  I should have just let her leave.

She brought the dog in to the ER.  With all of her pain.  A ginormous doberman.  The American's With Disabilities Act has some specific guidelines for what is and is not considered a service dog.  An untrained doberman?  Not so much and do I have to balls to tell her to get out?  Nope.  Because that would be considered insensitive, right?  Would my employer back me up?  Hell no.

"You need to keep that door shut".  Banging, clanging, dog whining, CDL yelling "heel!  heel!"

Eventually three genetically challenged looking individuals arrive.  "You can take her home, right now".

One of the  more intelligent looking said ominously, "We have to talk to her".

I waited exactly 45 seconds then banged on the door.

The Three Amigos were standing around watching this woman with excruciating, severe, debilitating pain bent over and mopping up the floor.  The sheet was off the bed.  The dog was actually ON the bed, placidly watching the sideshow.

"Please tell me that dog did not have an accident in my treatment room", I said icily.

"Fluffy knocked over my soda can!  It was an accident!  He's just so busy!"

Me: "You all need to leave.  Right now.  I have to get my housekeeper to completely decontaminate this room"

CDL: "We haven't worked out the details of how to get......"

Me: "I mean it.  You all need to leave immediately, this is just plain rude.  Take the dog and all of you settle this outside.  This is not fair to the next patient who needs this room."

CDL: "But I....."

Me: "Go.  Now."

Off they went.  I felt badly for the poor little housekeeper who said there was soda everywhere.

This just frosts my a$$.  Legitimate service dogs are needed by individuals with disabilities.  Lovely well trained service dogs.  What happens to all these great service dogs if this kind of shit is allowed to go on because crazy people declare that their untrained mutts wearing tutu's and Laker's jackets are necessary for their emotional support?  I heard of one guy who's service animal was mauled by what was actually simply a pet that went unchallenged in a store.  Now he has an injured and emotionally destroyed and useless service dog because someone decided the rules did not apply.  Does this make any sense?




Thursday, September 13, 2012

More Fun with Drug Seekers

Another busy night with the oh-so-wonderful Bobo was the usual  freak show.  We gave out 30 Percocet because certainly every single pain deserves to go home with at least four pills.  Right.  That was dental pain, chronic back pain, and various atraumatic aches and pains.  What a tool.  I had to get in his face and advocate for narcotics for a patient with a bad wrist fracture who really needed them; then she said she hated that stuff and wouldn't take anything stronger than ibuprofen unless she really, really couldn't stand it.  Sheesh.

I had to retrieve Drama Mama from the parking lot.  She had been hit by a car, having been standing in front of it when it accelerated. Three hours prior to arrival.  She arrived by private car without swelling, bruising or a mark on her.  "I can't stand up!"

 I won't go into the booooooooring detail here, but let's just say the mechanism of injury, while consistent with the degree of 20/10 pain the patient stated she was experiencing, was not evident in the exam.  In other words, she had pain everywhere but not so much as a ding.  And then there was the healing abcess on her forearm and that history of IV drug use that she denied and said it was from a fish hook.  She was so high on the last 2 visits that forgot her own story.

It seems the Dilaudid train had left the station without her.  She had been getting daily wound checks/packing/IV antibiotics (of COURSE she was not sent home with an IV, duh!) and multiple doses of narcotics at each visit because of her histrionics. Bobo, to his credit, was not convinced with Drama Mama's appallingly sub-standard over-the-top acting.  Apparently yelling about your pain (between cell phone calls to yell to yell to friends and family about life-threatening pain) is considered to be the ultimate test of veracity.

Bobo: Don't put an IV in her
Me: Duh
Bobo: Just go ahead and give her 1mg of Dilaudid IM

Drama Mama got her shot; moaning, sobbing,crying (without tears of course) she managed to very calmly ask me what side she should roll over to and then EFFORTLESSLY proceed to do so.

Eight minutes later she was on the call bell yelling hysterically: "It's not working!  I need more medicine!"
Me: "It will take a little longer than eight minutes to work.  But I'll tell the doctor"

Bobo was informed, at the 10 minute mark when he was done with...whatever he was doing, that I had given the shot exactly 10 minutes previously and she was refusing an x-ray until she gets more medicine.

He told her nothing more and that she needed to give it 30 minutes.

Ding!  On the call bell again (which, but the way, she had to get out of bed to retrieve because I failed to give it to her bad nurse that I am).  "As long as I have to wait a half hour I might as well have an x-ray"

Me: "Peachy!"

She managed to get another 1/2 mg Dilaudid out of Bobo before even he got tired of her and kicked her to the curb.  Drama Mama walked excruciatingly slowly with her enabler/handler/boyfriend twice her age to the doorway, yelling at him the whole time to "hold me up!", accompanied by much moaning, sighing, wailing and gnashing of teeth.

End of story?

Nope.

She was in the next day as I came to work, same complaint except this time she had embellished her story and added theft of her daughter's back pack and some oxycontin's, and that she had tried to stop them from taking the vicodin we had prescribed the night before by standing in front of the vehicle.  Not realizing the lie that she was hit by the car BEFORE she came to the ER.

And we didn't prescribe any vicodin.

Which proves that time travel IS NOT possible!










Wednesday, September 12, 2012

Fifty Shades of Drunk

Patients frequently walk unknowingly into the ambulance bay door instead of the main ER door even though it has a big-a$$ sign on it that says AMBULANCE on it.  This is right in the middle of the department work area so immediately all eyes are upon thee. It is like walking directly onto a brightly lit  stage.  Spotlight!

A couple walked in center stage, and the woman, realizing that she was on stage immediately put her hand to her head.  She had apparently passed out cold when she went outside to smoke a cigarette while out to dinner with spouse and friends.  She fell into a puddle as it was raining.

"I think it might be an allergic reaction"

She "didn't have much to drink...maybe it was the lobster mac and cheese.  My father is allergic to lobster".

"Not much to drink", it transpires, consisted of  6 beers and 2 margaritas over the course of the evening.

The woman asked if we would be testing her for lobster allergy.  Um, no.  You need an allergist for that, it's not an emergency.  She also continued to tell us that she doesn't drink much (not since they invented the funnel, ba-dum chhhhhh!), has a respectable job, children, responsibilities, etc, etc.  She was not an alcoholic.

And thus the middle aged couple continued to speculate, while the woman was rehydrated, that the cause of her syncopal episode was allergy (possibly), dehydration (quite likely), encephalitis, meningitis (improbable), or heart related (ruled out).

There was NO WAY it could be related to alcohol related since she just didn't have that much to drink.




Saturday, September 1, 2012

Defying Gravity

I worried about this guy.  IV drug user; hugely swollen and red arm, an abscess gone completely haywire, and it looked like it had been going on for awhile.  He was promptly triaged and placed in a room, the dirty used ace bandage unwrapped.  The smell was horrible.  He looked sick.

He left without being seen, scampering unnoticed out of the department after about 10 minutes on the premise of using the rest room.  Home number disconnected.  Police well-being check turned up an abandoned house.

Some people don't merely fall through the cracks: they plummet.  Perpetual free-fall.


Friday, August 31, 2012

It's the Most Wonderful Time of the Year


School is about to start, so it's time to have all those rashes, bug bites and aches and pains checked that kids have had all summer.  It is also the time of year for requests for school and sports physicals, and immunizations to be updated which we do NOT do; lack of planning on the part of the parents does NOT constitute an emergency.  This is just laziness because I know the local school nurses send updates in the spring notifying each grade level to start making their summer pediatric appointments promptly because they book up three or four months in advance.  It is pretty hard to get an appointment once June rolls around, and by the end of August you are just crap out of luck and your kid won't be playing sports without that physical form.  So just do it already.  Some people will try to parlay a bogus injury into a comprehensive physical exam, but we are wise to that and won't sign the forms.

During the school year we see WAAAAAAYYYY too many school-age kids at 9:00 or 10:00 PM with injury sustained during the day.  It is one thing to try common sense remedies such as RICE (Rest, Ice, Compression, Elevate) for hours and then bring the kid in because it is very painful.  Most often the complaints of knee, foot, ankle pain are reported near bed time without any intervention.  After a full day of school, sports, playing and jumping on the trampoline for an hour the kid reports the injury as "not better" and the parents race to the ER for an x-ray, walking without difficulty.

So I am going to go out on a limb here and suggest, as a public service, that this school year a little common sense be deployed when it comes to breaking land speed records getting to the ER for a negative X-ray.  See RICE, above.

Also, crutches are really not fun after about an hour.

Thursday, August 30, 2012

I'm So Dizzy, My Head is Spinning

A 63 year old man walked in with dizziness.  Dizziness is always so vague; it is a gateway symptom to something else that's going on usually.  In this guy's case, there was also a bunch of other stuff, including leg swelling for months, and oh, yeah, this numbness in my face.  He hemmed and hawed and thought out loud about each and every question which just makes triage so much more difficult.

Dizzy Guy was accompanied by a female friend; close friend from the looks of it and the way she tried to answer every question.  Or contradict every response he made.  Or point out another symptom.  Or correct a time frame.  Or rat out yet another symptom.  Or embellish and speculate on every triage question.

Me:  Are you diabetic?

Dizzy Guy: Well, I haven't seen my doctor in about a year, so I could be...

Dizzy Girlfriend: He has to be...

Me: To be clear, you have never been diagnosed with diabetes or pre-diabetes and are taking no medication?

Dizzy Guy: Um, no, but sometimes my blood pressure is up.  I have some back pain, and I.....

Dizzy Girlfriend: He has been under a lot of stress at work; I want you to write that down.

Dizzy Guy: I'm FINE.  I'm NOT having a heart attack.

Dizzy Girlfriend: I want them to know everything and you don't tell them everything....

Dizzy Guy: I have been having some leg swelling, but I think I've been walking around a lot..

Dizzy Girlfriend: I think he's been trying to cover up the fact that he's been short of breath when he walks

Dizzy Guy: Not really, it was hot yesterday and I was...

Dizzy Girlfriend: Yes, I really think he was!  And he didn't eat as much as he usually does, and...

Me: Time out!  Let me just talk to Dizzy Guy for a minute, mmmmkay?

Dizzy Girlfriend: OK, I'll shut up.  Did he tell you about these little dots on his legs?  And why does it look like they are 2 different colors...

Me: Why don't you have a seat over there for a minute?

Dizzy Guy: She will drive you nuts.

Dizzy Girlfriend: I'm just looking out for you

This exchange was rapid-fire, neither one could focus.  And they kept interrupting each other AND me.  I became frustrated being unable to get a word in edgewise so I kinda lost it.

Me: OK, nobody talk but me, then I want the Reader's Digest abridged version unless I ask.  Got it?

Things deteriorated when the doc told them Dizzy Guy might be having a TIA.

Dizzy Girlfriend: (yelling into the phone) He could be having a TSA!  He has to go for a CAT scan!
Dizzy Guy: Is she driving you crazy yet?

Me: (banging head against desk) TIA!  TIA!  TIA!  TSA is at the airport!
Partner in crime: Well, at least they won't need the complimentary strip search.

I pulled a 7th grade Vocabulary Workshop word out of my a** and pronounced them garrulous.

As he was wheeled away, the paramedics offered him a blanket.

Dizzy Guy: Well, I don't know, I could.  I really don't need it, but I suppose I could take one and....
Me: Just take it!  It's a blanket, not an investment decision!

They were nice people, but exhausting.







Wednesday, August 29, 2012

Welcome to Acronym Hospital

Acronyms are, of course, wildly popular in health care.  I don't think the job would be nearly as much fun without them.  "Medical speak" is cumbersome and the average person usually doesn't know everything we are talking about even if we use the actual language.  It can be confusing for people in health care as well, but there are some basic acronyms that people are expected to know like in the first 10 minutes of their training.  Take Wednesday, for example; surprise, surprise.  She overheard Eeyore tell me that she had just put a patient in treatment room 2 with SOB.  This is one of the biggest jokes in health care since it means "shortness of breath", rather a garbage term for someone with any complaint ranging from cough / man cold to pulmonary edema.   Wednesday was aghast that Eeyore was so rude to refer to someone as a Son of a Bitch.  Right.  Bonehead.

At some point hospital administration jumped on the Acronym bandwagon.  Where I work not a week goes wherein the Suits in Charge of Stupid Shit does not devise a new set of "catchy" phrases to go along with their latest so-called motivational agenda.  SPIRIT and CARE are two of the latest to hit the hospital.  The Suits apparently spent months on those with little else to do after the massive reduction in force.  Then they wonder why their employee surveys suck.

It didn't take Kate and I months, but rather minutes to come up with new meaning for SPIRIT.

S  squirrels....'nuff said
P  plenty of Percocet for all!
I  if it is difficult, we might do it.  Impossible?  Fu*k it.
R  really??!! Your prescription for narcotics was lost / stolen / thrown away / eaten by wild dogs??
I  if assholes could fly, this place would be an airport
T  totally allergic to tylenol, tramadol and toradol.  But the dilalalalala stuff works purty gud.

Suits spend seemingly endless hours in useless meetings to try to devise work- arounds  to improve satisfaction scores.  They don't seem to get that better support of the nurses would reap ten-fold rewards in that arena.  They are not getting that people who genuinely believe that their management cares fu*k-all about them are not in the greatest position to be institutional cheerleaders.  Plus we know they think we are stupid and don't remember stuff.  Like, in this electronic age, why are you still doing employee mailers?  Stamps add up.  Or the cafeteria closes at 5 PM, now 2 hours earlier which says "screw you" to the evening shift.

Honestly, we just don't care about your so-called "Service Recovery" acronyms.  We spend lots of time enjoying making fun of them, though.  Same goes for "Key Words at Key Times", which will be tomorrows topic of conversation.

Service Recovery employs the HEART acronym.  It stands for HEAR the patient, EMPATHIZE, APOLOGIZE, RESPOND, and THANK them.  Seriously.  The following is an example of how we, as nurses, are expected to respond to rude behavior from patients and families.

"I understand that you are upset.  I know how frustrating this must be for you, and I will do everything I can to get you into a room as soon as possible.   I apologize for the long wait, but I promise you will get the same careful, comprehensive exam and care when it is your turn.  Thank you for choosing our health care organization"

Seems like a good idea on paper, but in actual fact it pulls nurses away from the bedside and rewards bad behavior.  Monkeys then copy that bad behavior so it is a losing battle to employ that kind of psychology.

So,  to put some perspective on this scenario, imagine that you are are a patient sitting in the packed waiting room with abdominal pain, a febrile child with an earache, or a deep laceration.  You are a reasonable person with reasonable expectations and expect that you may have to wait.  As a reasonable human being you *get* that other individuals may be sicker than you are, have life threatening illness, and might require more intervention thus stretching our limited resources.  So keeping my little speech in mind, now imagine that I am responding to a highly negative verbal assault, shouted in your presence or that of your young child.  You could not be aware that this individual has dozens of visits for the Holy Trinity of Chronic Pain Complaints, nebulous injury with severe pain requiring narcotics, and an affinity for being disruptive.


"This is bullshit!  I have been waiting 30 minutes!  I'm going to talk to my lawyer if I don't get some answers and see a doctor!  What is the name and number or your supervisor!  All you people do is give me the runaround!  I have real pain issues!  I'm leaving"


As a patient who is being reasonable, playing by the rules and waiting your turn, are you going to put up with my decision to reward this type of behavior by immediately taking him into a room?  No, you are going to be pissed unless you are one of those parents who tries to calmly explain to their 2 year old who is banging the dog on the head with a hammer why it is a bad idea to hit Fido on the head.

Instead I say something like "Ok, sir have a nice day there.  I'm calling the police"

Many thank me for my own brand of service recovery, tell me they appreciate the way I handle it, or simply applaud.

Thank you very much; the bullshit has left the building.










Tuesday, August 28, 2012

Stuff I Wake Up to After Dozing on the Couch After Work

OK, the sound was off.  I woke up and saw this on TV:

3 youngish looking guys. One of them is wearing Sally Jessy Raphael red glasses.  One looks like a Jonas brother.  One looks like a combination of  a so-called "Guido" from Jersey Shore and Uncle Jessie from Full House.

What are they singing?

A.  Girls Just Want to Have Fun
B.  Some Menudo song
C.  Opera.

Hint: it was a rerun of Kathie Lee and Hoda, which I wouldn't be watching at 11:00 AM, never mind at 3:00 AM.  It was really way past time to go to bed.


Monday, August 27, 2012

I Don't Flirt

A 42 year old guy came in for a suture removal.  Yes, we do this.  We used to do it for free, now I'm told it is something that gets billed.  It was a worker's comp, so whatever.

The guy was the tiniest bit goofy, and had a fairly androgynous looking kid with him of indeterminate tween age, I just couldn't tell if it was a boy or girl.  Turns out it was a girl.  "Will there be blood?", she asked as I got out the scissors.  Wasn't that a movie? 

After the sutures were removed and I prepared his walking papers, I teasingly asked the little girl if she saw any blood.

Dad: "Hey, you said that like you have kids"
Me:  "Oh, sure.  I have kids your age"
Dad: "What?!  That can't be true.  You're too young to have kids my age!"
Me:  "I had my first when I was about 12, so yeah.  About your age"
Dad: " No, go on!  You're joking, but you are just too cute"
Me: "Um, well thanks for making my day"

Flirting, me?  Yeah, no.  I was being a wise ass.  HE was flirting.

Sunday, August 26, 2012

Be Prepared...Just Sayin'

0-60 MPH in this ER.  23 patients one night, 5 the next.  Even the phone calls were boring; the Lady on Elm anonymously called to see if Sherry was working although I knew it was her.  Nervous Lady called to see what time we closed.  Then called back to see how late she could come in for x-rays.  Then called back to see what time the lab opens.  She does this several times per week, we suspect she is really a mole for the Suits to try and catch us in a lie.

My hospital mandated competencies were all up to date, People magazine was read, and the place was stocked and tidy.  There is only so much internet surfing you can do since most sites are blocked.  That left us generally free to listen to the scanner and catch up on all the delightful antics of the community in which I work.

There were about 5 calls for local police / ambulance to a nearby apartment complex for this and that; fall on floor, unresponsive but breathing, back ache, suspicious activity.  Annika, a lovely per diem radiology tech was taking advantage of the quietude to make a phone call on the veranda (ambulance bay) when she noted the Whole Nine Yards speeding by with lights and sirens; 2 ambulances, an undetermined number of fire apparatus, every police car in town.  Double overdose in the same apartment complex.  Now would be a good time to commit a crime in town, but not to have a medical emergency.

The victims were known to abuse lorazepam according to dispatch.  Well, I though as I got out the IV drug handbook.  Let me read about administering flumazenil and how to reverse benzodiazepine overdose since I haven't done that in years.  Just on the off-chance that the patient might be brought to my ER.  Remote, but possible.

Mac noticed the commotion outside and inquired as to what the call was; he also noted that I was looking up drug reversal recipes.

"Where is your I-O stuff?" he asked.  "If we get it ready, we won't need it"

Good call.  We amused ourselves with code cart stuff while we waited.  And waited.  And waited.

We didn't need either the I-O stuff or the flumazenil, but at least I put my down-time to good use.


Saturday, August 25, 2012

What's the Temperature?

SIC was reading some study about temporal vs. oral temperatures that she just had to share, I wasn't really listening since I was reading the latest issue of People magazine.  The study said something about oral temperatures being more accurate on kids aged 3 months to three years, although a rectal temp is the gold standard for babies.  That caught my attention since why anyone would bother even attempting to take an oral temp. on a 3 month old defies all logic so I wrote the data-reporting off as bogus and stopped listening altogether.

Until my next patient limped in with her veterinary tech boyfriend with a stubbed pinky toe, who said she had an extra foot bone that periodically dislocates and it felt like it was out of place.  Vet tech had actually wrapped the foot in several yards of purple vet wrap; we have the same thing for humans but we call it Coban, sort of an elastic self-sticking tape that comes in all different colors.  Paeds nurses used to yell at us when we used it to secure the IV's of admitted babies, but it works great on them.  Dogs too I imagine.   I suppose stubbed pinky toe was grateful that vet tech boyfriend didn't have any other stray veterinary equipment lying around such as this:

"Why??!!!"


Vet tech was fascinated with the temporal thermometer, and commented on how awesome it would be to be able to use something like that on dogs instead of rectal.  And then my mind started to wander envisioning dog-wrangling and trying to get a temporal thermometer to work.

Me: "Yeah, I guess rectal temps will remain the gold standard for dogs", which sort of put into perspective the whole oral temp on babies thing.  And then my mind wandered again and I thought about how awesome it would be for dogs if Vet wrap was bacon flavored....



Friday, August 24, 2012

Thumbthing Wicked

Story time; unusually quiet night.  SIC talked about a patient who had scarred her for life with a particularly horrible thumb amputation, some kind of outdoor industrial-type accident that occurred during a below-zero day here north of the Arctic Circle.  It was so cold that she had to peel off 8 layers consisting of orange day-glo vest, other vest, jacket, coveralls, flannels, long sleeved shirt, long underwear shirt and silk underwear before discovering that not only was he missing a thumb, but his ulna and radius were poking through the skin.  Then she described having to retrieve the thumb from the front seat of his truck (he drove himself to the ER) and having to shake the amputated thumb out of the glove.  Urp.

I once had a man chop off his own thumb with an axe (fairly common), except he came to the ER without the amputated part.  It was missing.  His family was searching for it.  The search lasted for nearly an hour and feared that the family canine had absconded with the the thumb.  Fortunately  it was found near some canned goods in the basement.  The thumb, not the dog.  Bobo was concerned that the family should know exactly how to transport the thumb.  Yes, I told them to put it in a baggy.  Yes, I told them to put the baggie on ice.  Yes, I told them not to put the thumb directly on the ice.  Finally the family calls to alert us that the thumb has been located and is on the way; the dog is in the clear.  I relay this information to Bobo, who is a genetically humorless individual.

Me: "So, the wife has located the thumb and is on her way in"
Bobo: "Ok, good; they have it on ice, I heard you telling them how to pack it"
Me: "Yep.  I have just one question though"
Bobo: "What's that?"
Me: "Do I have them register the thumb as a new patient?"

Bobo actually laughed for about 2 seconds before he composed himself.  I don't believe anybody has ever heard him so much as snicker.

I know.  I have a dark gift.

Thursday, August 23, 2012

Working Together, Yeah.

I don't let people abuse the registration staff and encourage them to simply excuse themselves from confrontational individuals and let me or the other nurses handle it .  I have even rescued Wednesday from rabid patients.  For one thing, I just don't give a rat's fat  ass how long the out-patients are waiting if there are ER patients;  that is the lab's problem and something they need to fix.  It is not the fault of the registrars if the barely-there phlebotomist decides to have lunch at 2:30 PM every day and the lab manager allows this regardless of how many blood draws there are.  FYI, that is a very busy time of day for both ER and lab.  Work with us, please.  Still, it is unacceptable to treat any member of the staff disrespectfully.  Manners: get you some.

Eeyore is usually pretty good at deflecting things; Ellen has a tendency to get flustered and apologize all over the place, then come and find me when the yelling starts.  It makes it more difficult if I intervene late in the game, but that's my job I guess. I have no trouble firmly but unsmilingly telling people to calm down because the registrars are doing their best to accommodate their rude asses, while I am mentally telling them to take a double flying fu*k at a rolling donut.  And then I add 10 minutes to their wait time.  I am not at all passive aggressive.


There are some hot-button questions that seem to rankle, as if we are making things up just to piss them off.  Really?  Don't you think if we had any control over these things we would streamline the process more?  Or at least ask more fun questions, such as "What color is a red house?", and "If a monkey can climb a greased pole in 10 seconds, how much does a pound of butter weigh?".

But no.  Mostly it is the mundane that set people off.  That, and unrealistic expectations.

You asked for all this information last time
Yes, I know.  Gets boring doesn't it?  So does your excuse for failing to have an ID.  Or insurance.  Or  an address other than a PO box 2 hours away.  Because we all we are really trying to do is catch you in a lie, right?

My doctor's office has all of this information on record
Your doctor's office computer thingy doesn't speak to ours.  It is a 9-5 computer thingy anyway, and since it is after 5 PM, it has gone night-night.

My doctor told me this was an emergency and I should be seen right away.
When I called your doctor's office (thus wasting 10 minutes of my life I will never get back) to ask them (to take time out of their day) to fax me your medicine list (that you should know yourself), they informed me that you had (but didn't think you should wait an additional 90 minutes) for your scheduled "urgent same day appointment" (for something stupid).  You have just guaranteed that you will not be seen before then.  FYI,  99 degrees Fahrenheit is not a high fever, and saying you "felt warm all day" confirms that you are an idiot.

"Are you going to rob me?"
 Asked of  Ellen by a complete douche-tard during the obligatory request for insurance information. Highly unlikely since you have no insurance.  Or any ID.  Or have given us a bogus address.  More like you robbing me since you have no intention of paying your bill.

You don't understand why I'm calling the police?
You just threatened to "go off on me" and "make me sorry I was ever born" if you were not seen immediately.  Buh bye.  Have a nice day.

Which brings me to the Last Word in conflict negotiation.  The Last Resort.   I am eternally grateful for all the support our local police gives us.  It happens often enough that it is necessary to call them, usually when the decibels exceed polite levels and violence is threatened.  The prospect of the special little "adult time-out room" with the metal bars almost always takes things down several notches.  I especially like it when they say, "Now, is there anything you want to say to the nice nurse who is just doing her job?" as they are led away.

Really.  Buh bye.


Tuesday, August 21, 2012

I'll Be Calm When You Leave. I Promise.

The working environment in an ER is labile, obviously.  ER nurses wouldn't want to work there unless there was some variety now, would we?  Most of us could never work anywhere else, but that doesn't mean it's all wonderfully sunshiny and glittery.  There are no unicorns defacating  rainbow colored poop, let's be clear.   And let us not forget about the DRRRAAAAAAAAMA.  Distraught patients and families, unfulfilled drug-seekers, and teenagers are not the sole providers of drama.

As for drama, I personally  don't care if the world is going to hell in a hand cart patient-wise as long as I am working with people who are calm and orderly as well.  I do not respond well to individual mayhem, chaos, and people spinning will-nilly in their own disorganized orbits.  Just take a breath.  It is not time to panic until it is time to panic.

Gil likes it calm; we enjoy taking a deep breath together as the day shift leaves, taking their chaos with them.    I like my own inner peace to prevail even if I am racing from task to task.  There are some combinations and groups of people who work cohesively, work as a team, and make the experience pleasant.  If nothing else there is a common hatred of management bullies and company bullshit.  The more "big personalities", "lone wolves", "chronic complainers" and "debbie downers" who are part of  the work environment, the more unpleasant it becomes, which has a tendency to mess with my inner calm.

Things that generally fu*k with my chi:

1.  Wednesday, the lab tech.  She is like nails on a blackboard.

2.  Eeyore on a day after she calls in sick because she just fu*king whines and I want to hit her.

3.  The air conditioning on the fritz.  For the entire weekend.

4.  Patients who come in five minutes before we close for crap that's been going on all day/week/month/year.

5.  Coworkers who whine about the schedule because they didn't get to it first.  Haha.

6.  The Lady on Elm St. calling for the 4th time.  In one hour.

7.  Patient's with silly reasons for being in the ER who want warm blankets, 3 pillows, an ice pack, an additional 4 more "something I forgot to mention's", are talking on their cell phone and want change for the vending machine because they need a little snack, coloring books and crayons for their demon spawn and are pissed about the wait, all in the first 10 minutes of the visit before the physician has a chance to see them.

8.  Any shift with Parvati because she yells orders to the universe in general and calls me Nancy repeatedly.  Which I ignore because my name isn't Nancy.


Quit fu*king with my chi.  Honestly.  We'll all be happier.
Now just go breathe somewhere else, there's plenty of oxygen over there.

Monday, August 20, 2012

Not Time for Lyme

Non-stop madness, no time for anything and we get about 3 people at once for "tick bite", "I think I have a tick bite", and "is this a Lyme disease rash".  One turned out to be a mole, one was a mosquito bite and the rash?  Who knows.   Not Lyme.

You would think that if people were living in one of the biggest Lyme corridors in the country that they would educate themselves on what to do if they encounter a tick on or near their person.  Sometimes people bring ticks they have recovered from their PETS to have them "analyzed to see if it is a deer tick".  No.  We don't do that.  Mostly it's unidentifiable tick parts.  Or spiders.

Even if they have consulted Dr. Google, people seem to skim over the bits about how tick-borne illness is acquired and  symptoms to watch for.  But they still come screaming into the ER as if they had just found a black widow spider in their Underroos, paying no attention to the fact that the Lyme disease tick is quite tiny.

Just a general informational tidbit here: ticks cannot fly.  If it has wings, it is NOT a tick.
   
It depends on the doctor how much of an intervention will be carried out in the ER.  Mostly we just give them a dose of antibiotics and kick them to the curb.

The tick may be removed with a little plastic spoon with a notch cut into it.  Or a 20 gauge needle.
The area might be anesthetized and the tick removed with a scalpel

The patient may or may not have a Lyme titre done.  This is kind of useless as an indicator for Lyme if a tick has been on your body for 10 minutes.

Not to be an alarmist but there are many, many more tick borne illnesses to be afraid of.  Very afraid.  Don't even get me started on rabies exposure.



Sunday, August 19, 2012

Listing and Such

Just one more reason why the fun and creativity is sucked right out the job:  I am no longer allowed to number medical complaints what with the new-fangled eeeeelectronic  medical records keeping system and all.  For some inexplicable reason any triage complaint chosen from a pre-loaded list gets immediately coded.  We are discouraged from adding multiple complaints because it opens up a couple of cans of worms.  In the past, I would simply do this for multiple frivolous complaints:

1.  Man-cold
2.  Rash x 3 years
3.  Requests psych med/pain med refill
4.  Work excuse
5.  Ingrown toenail

Succinct.  Easy to read.  Says, "I'm listening, but not very hard right now", and says a lot about the patient without really having to say anything, right?

So now I could just put it all in a free-text stream.  It doesn't look as eye-catching when I write:
Pt. states: Cold, rash x 3 years, wants medication refill, a work excuse and an ingrown toenail.

See?  Just not as effective.

Along with a litany of complaints that I am now no longer allowed to number was a female, age 30, with:

Facial pain.  Low back pain.  Knee pain.  Constipated.  "Feeling weird".  "Feeling warm" (not febrile).  Peeing less.

She did have a number of medications for anxiety, chronic shoulder pain and fibromyalgia.

Except she pronounced it Fiber Mal-Eye-Ja.

Really.  Yes, she was a native English speaking individual.  She also mispronounced Klonopin (Klonda-keen), Gabapentin (Gabro-my-pentathol), Lorazepam (Lora-pm).