EDNurseasauras, Still in the Trenches

It's All About the Privacy

2012-01-24T19:16:00.004-05:00

A 31 year old female came in with a female friend for a sebaceous cyst, a nice big ripe one behind the ear. It had obviously been brewing for some time, so Bobo elected to I&D it. But first, Ativan, then nice big does of Dilaudid. She screamed such a string of obscenities so inconsistent with what he was doing that the usually unflappable Bobo was unnerved; he who as a general practice gives out Percocets like Pez and is not stingy with the lidocaine or giving it time to work. He actually mouthed, "WTF" to me. I had to dive under the table on that one.

Eventually I managed to scrape her off the ceiling, apply a dressing and send her off to the pharmacy to fill her antibiotic and narcotic prescriptions.

Two hours later (and the woman had been in the department at least 2 hours), I got a phone call.

"Hi, I'm calling to see if my girlfriend is there".
Me: "I'm sorry, I'm not allowed to give out that kind of information, it is against privacy laws" (in other words, stupid, she's not here for me to ask her if she wants to take a call or have me take a message).
Idiot: "Well, I know she came there, and I know she needs a ride home so just tell me if she's there or not"
Me: "I can't give you any patient information. Sorry". (You could also be a stalker, maybe she has a restraining order on you, maybe you have a gun, and maybe you are crazy. Or not, but I don't really care)
Idiot: "Listen, I just have to know if she was there, um, I mean, I just need to know if I need to pick her up. You don't have to be a bitch about it"
Me: "I'm hanging up, have a nice day"
Idiot:: "I'll just come down and see for my-..."
Click. Hey she came in with a friend, obviously she doesn't tell him everything.

We walk a fine line with the kind of patient information we give out over the phone. Obviously, we want to do what's best for patients. We talk to caregivers, and lots of times we talk with family members. Do we try to ask for permission first? We do if it is a non-urgent problem. Are we going to talk to three aunts, a cousin and a grandparent for someone with a minor laceration? No. Are we going to talk to family members who have been alerted by the nursing home that their demented elderly loved one has has been brought in with stroke symptoms or chest pain? Hell yes.

We don't leave messages on routine call-backs or for lab tests, but do suggest they call us. Nor do we give information for such requests as "I just wanted to see what my girlfriend's/boyfriend's STD test showed". Sorry, you'll have to that information from her/him. But if you are worried about that nasty discharge, come on down.

Once I had a director of nursing at a big hospital call me, the charge nurse, looking for information about her adult daughter. She was being seen in my ER for a non-urgent problem. I told Mom that I was sorry, but giving her any information would be a patient privacy violation and that she would have to ask the daughter. She thanked me and agreed that it was. My next move was an immediate call to my boss to cover my ass. Five minutes after I hung up with her my boss called me back to say the director had called her to praise me for protecting patient privacy and to congratulate my boss on training her charge nurses so well; she was embarrassed that she had been so careless about this issue. You would think she would have known better, but the Suits and Clipboard Nurses who make policy rarely have any idea how these things work in the real world.

Sometimes it is just a ridiculous game that puts us in the middle of family issues. An example of this is a 25 year old with a minor laceration who was know to be an IV drug user. It was not an injury that in any way, shape or form would have needed narcotics, so he left an unhappy camper and was quite nasty about it. An hour later his mother called saying how much pain her son was in so could she please come down and get a prescription? And his tooth was hurting too. I said I couldn't discuss her son's care without his permission. A short time later Sonny called and said we could give the prescription to his mother but we weren't allowed to give any details about his care or any part of his medical record. Um, no. You are still not getting a narcotic prescription. You have my permission to talk to your mother.

Code Rainbow

2012-01-21T22:52:00.006-05:00

We don't have security. When there is trouble the local police are but a 911 call away. They are always prompt in coming to our aid to either kick ass or talk people out of a tree. They also know what time we close, and unless they are really busy there is always an officer waiting for us as we alarm the bulding and disperse to our cars in a dark and secluded parking lot.

It is nice that they are protective like that even if we rarely get the aggressive or dangerous patient. Drunks? Never come by ambulance. Overdoses? Occasionally thrown out of cars onto our doorstep, but they are the exception rather than the rule. I truly don't miss that about working in a city hospital.

One night we got a 6 ft 2 inch 18 year old male whose parents had come home to find him lying on the floor, " not responding". I don't know how, but he was carried in by his father.  He could walk, but wasn't really doing what he was told; he also had slurred speech and was "not really cooperative" (he took a swing at me). He was drunk, of course. Shocker. So I was concerned enough about my/our safety to call dispatch and have them send over some hefty police presence.

Cripes: "Why did you do that? Don't we have any leather restraints?"
Funny. Real funny.

Cripes told us, "When I was in residency, I tackled a psych patient in the hallway. We were wrestling around, and I yelled for the nurse to call a Code Grey for security. She got all huffy and said, 'Well, that would be a Code Green'. Seriously?"
Me: "Ha. More like a Code Black and Blue".

I get it. What Cripes was referring to was the method utilized by most health care facilities to immediately broadcast some sort of internal threat or emergency situation which are often color coded so that visitors and patients aren't freaked out. It would be chaotic and dangerous, especially to bed-bound patients if some things were broadcast in an overhead page like, "Bomb Threat, GET OUT IMMEDIATELY", or "FIRE! As if anybody is fooled by an overhead "Code Red! Code Red! Code Red" even if it is just the ICU nurses burning popcorn.

"Did you order the Code Red?"
"Your damn right I did! But the popcorn is inedible!"

A Code Red in our community also means a  reverse 911 system to notify citizens of school closings, tornadoes, or local flooding with road closures which we are prone to, and other natural and unnatural impending disasters. I generally have a surge of adrenaline when I pick up the phone at home and hear "This is a Code Red alert!" when the water is up to the door of my barn and the road is impassable. This usually means I have to find another way to get to work, but I can generally just look out the back door to determine that the creek is overflowed. The car lying in a puddle up to its roof is a dead giveaway.

These codes are not standardized from place to place. This makes it confusing so other than codes for a cardiac arrest or a fire I can never remember what some of the colors are. A Code White, Grey, Green, Yellow or Orange might be used for different emergencies or not exist at all at some of the various facilities I have worked over the years.   Obviously we never use them where I am working now, but if I had to work at the Big House I would need a cheat sheet. Good thing the codes are printed on my ID badge.

Super-secret codes for emergency situations in the hospital undoubtedly fool nobody. The cat is kind of out of the bag when "Dr. Ambu", "Code Blue", "Doctor Blue, Stat", and "Code 99" is paged for a cardiac arrest, especially when a dozen people rush by with an automotive cart trailing jumper cables. I worked at the "Code 99" hospital for many years, and had more than a few adrenaline rushes at the local supermarket when they paged "Code 9" for a manager check approval.

There are codes of various colors used for things like Haz Mat alert, Internal Disaster, Mass Casualty, Missing Infant from the nursery (in which the entire hospital goes into immediate lock down), and others. Some of us added to the list over the years during times of intense boredom. "Code Rainbow" referred to the choice of a liver entree in the cafeteria, notable for the lovely rainbow colors it took on when sitting in its un-appetizing-looking liquid. One of the lab techs had an odd habit of wearing an entirely color-coordinated ensemble from head to foot. If she was wearing red, for instance, she would have on red hose, shoes, jewelry, slip, hair appliances and underwear (we took her word for that). We referred to some of her more bizarre outfits as a "Code Puce and Chartreuse" as she had a weird penchant for those particular shades of purpley-brown and yellow-green.

Among the re-tooled emergency codes include "Code Squirrel", when we are overrun with drug seekers, "Code Blah" for something boring in the cafeteria, and "Code Chicken Little", which meant that the charge nurse was spinning in her own orbit and the sky was falling.

The latest code is an ID-10t.   Lisa started using it when dealing with persons of less than average intelligence. I have since learned that it is actually a tech term humorously used to describe user errors in individuals with limited computer skills. I have no idea where this originated, it wasn't me but I like it a lot. Look at it. It spells.....

That's Why the Lady is a....

2012-01-17T22:04:00.020-05:00

I got an urgent phone call from Ellen on my day off.
"Hi, EDNurseasauras? Sorry to call you but the nurses were very busy and asked me to go down the list. Is there any possibility you could come in and help out?"
Me: "I'll be right there".

I have only gotten a call like this once at my current job. My name is at the end of the alphabet and they usually find someone before they get to me. Usually Second in Command, whose name is at the beginning of the alphabet, gets this type of urgent call and jumps right on it because she is an Overtime Whore. Me, not so much. Except lately because Kate has been going through some health problems and I have pretty much made myself her personal bitch when it comes to covering her time. Also because it annoys the crap out of Second in Command.

I made it to work in about 7 minutes, expecting that there would be 2 Medflight choppers circling, simultaneous codes, any number of disasters.

Instead, I walked in to find 4 patients awaiting transfers because Inappropriate Drop paramedic was working today. Among the things that shouldn't come to us but did thanks to Inappropriate Drop paramedic:
Head injuries
Probable hip fractures
End Stage COPD'ers (unless coding)
Transfers from doctor's offices with beds at the hospital. The OTHER hospital
and.........
The Lady on Elm St. with vomiting. I fu*ing hate Inappropriate Drop medic sometimes.

Not just regular vomiting. Lying flat on her 400 pound back and just letting it rip like Mt. Vesuvius. Because, she said, "Whatever I put in just comes right back up".

When things come right back up, it is probably an indication to stop putting stuff in. Like Cheeto's. Not a concept she'll be getting any time soon

Lady was the straw that broke the camel's back, a clean-up job requiring reinforcement nurses.

Quote of the Day

2012-01-06T14:30:00.000-05:00

I still don't understand why people come to the ER in search of a pelvic exam. This, the most personal and private exam a woman can be subjected to, and you want a total stranger to do it? I guess some people just don't care and consider it the price to be paid for a prescription for Percocet for their 10th visit this year for "painful periods", "my ovarian cyst is bothering me", and "painful intercourse".

Seriously?

I have had a run of days working with Gil, who is an older guy. After setting up the 4th patient of the night for a pelvic for a frequent drug seeking squirrel, Gil rolled his eyes. "Doing a pelvic", he said, "is like going on a treasure hunt for really bad treasure".

Yup.

What Happened to September?

2012-01-01T23:58:00.012-05:00

Happy 2012 to all. I don't know where 2011 went.
I guess I have been slacking the last couple of weeks although the holiday season gave me plenty to write about. I have tons of material, stacks and stacks of notes and pithy observations (ha! I am not sure I am capable of such). Some of them are actually humorous and possibly worth reading.

It is equal parts lack of motivation, time, and resources. It doesn't help that my laptop is on its last legs. I have spent the last 4 1/2 years pounding the crap out of it and I have decided not to keep it alive with heroic measures. I will eventually bury it at sea or run it over with my car.

More soon.

Status Update

2011-12-20T01:52:00.023-05:00

Our electronic patient status board lists all patients in the department so we can tell at a glance which ones are waiting to be seen, who is in what room, which doctor or nurse is assigned, what tests are finished or pending. Kind of like Facebook. It is the nurses' responsibility to discharge the patients off the board when they leave the department for good. For added fun, last week the word "dirty" popped up on the status board when the patient was discharged. Just to add 20 more steps to an already cumbersome and non-user friendly system, this necessitated entering "clean" when, obviously, the room was ready for another patient.

We complained, of course, since the nurses at this facility have to do the discharging, cleaning, and removal from the status board. The Information Techies must have been having a slow week taking turns offering Kudos to themselves on the Bitch Board about how awesome and effective their department is because they got right on it.

Now, to enhance the happy, happy, joy, joy, how wonderful for us to use only positive language, our status board no longer pops up the "dirty" notation.

Now it says "Unclean". And we still have 20 oh-so- convenient steps to change it.
Dislike. Bastards.

Just Thinking...

2011-12-19T21:37:00.003-05:00

We had a discussion of how much is too much for Christmas when it comes to grown-up kids. I put a halt to Christmas stockings this year for both of my kids and Mr. Ednurseasauras. They are fun, but I invariably find the contents of the stocking stashed in a bag in March (or June, or September). I found several years of assorted stocking stuff for K in a box recently which didn't make me happy. At least J always takes his stuff with him.

Sherry has two married step-kids in their mid to late 30's, one of whom has a young child. She also has a daughter with her first husband who was recently married who is in her early 20's. Sherry's plan was to get some kind of bigger ticket household item for the one couple with the kid, and knit a Christmas stockings for the other. Since Sherry had just hosted her wedding, the recently married kid was getting nothing. Sherry thought this seemed equitable. Her rationale was that she was putting a lot of time and effort into the Christmas stocking

"Wrong. Wrong. Wrong. Wasn't the older kid just saying last week that she didn't feel like a close family because she felt like you and your husband excluded her and favored your daughter? And wasn't this after she had a lovely wedding of her own last year? Jeez, she's nearly 40! Of COURSE she's not going to think a Christmas stocking is equal. Sad but true"

Sherry: "You're probably right. (I have learned that this response is code for not necessarily agreeing with me). When she was growing up the older one's mother didn't allow to have Barbie dolls. When Ella got one, she went ballistic. She was 13 and Ella was 3. She's never forgiven us for it"

Ah, the Barbies. I wasn't allowed to have one either. They were too....grown up. I had a "Tammy" doll, which I never knew until recently was only made for a few years and is considered very collectible. Tammy had more innocent features and a body that looked like way less of a Ho than Barbie's. That also meant that Tammy could never wear the more glamorous Barbie outfits.

I never really quite "got" playing dolls, dressing and undressing them for hours seemed like a pointless activity, and I quickly tired of playing "prom", "date" and "wedding". Me and my Tammy were perennial wedding guests, never even a bridesmaid let alone the bride. I would rather have read a book.

If I had a choice of playing dolls or poking needles into my eyes I would play dolls, but not graciously.

In the 1960's, girls didn't have multiple Barbies. They had one. If they were really lucky, they might have a Ken. The thing I coveted most of all was the little sister Skipper doll because she had long, brushable golden hair. I would have traded Tammy and both of her outfits, as well as the homemade poncho and scarf in a heartbeat to be able to play with Skipper. There was some scandal about someone's brother's cutting off dolls' hair to make hay for the horses when they were playing circus, but it wan't any of mine. I didn't have that many dolls.

My daughter K had lotsa Barbies, which have found a permanent home in an old gym bag in my basement. J, or course, didn't play dolls. But he inherited a big trash bag of Master's of the Universe figures from that Beckett kid who lived on the next street. His whack job father simply decided he didn't want them in the house anymore. Dad probably should have been paying more attention to the fact that Beckett was, at 6, regularly peeing in the bushes in my back yard. They were....odd people. He would have played with Barbies I think, but would have been the one to pull the legs off and bury them in the garden.

More Head-Shaking Lady News

2011-12-17T11:14:00.094-05:00

Sherry got out her knitting, which is generally an invitation for the masses to come streaming in. Since we were working with Parvati, the simplest dispositions become an all-out attempt to keep the patient there as long as possible by racking up a high number of diagnostic testing points. Some people have just one more visit before they win a toaster.

But Sherry was determined. "I have to make 3 hats, finish a Christmas stocking, and I'm working on a pair of socks. I will never get it all done in time for the holiday", she said.

We discussed the Christmas Madness Project, in detail. She shamefacedly told me she had bought a few items for the Lady on Elm St. Slippers, a pair of sweatpants, a nightgown and a couple of other things.

Excuse me? WTF??

Sherry: "I know, I know. I just feel really bad for her".

Well, so do I. Yes, why not pass the hat. Again. But Sherry had forgotten one very important point.

Me: "Sherry, how are you going to get that stuff to her? She takes offense at everything we do to try and help her"

Sherry: "Jane thinks we should just leave the box on her doorstep with a note, From Your Friendly Neighborhood Health Care Providers. Either that, or send it through the mail. Or my husband can drop it off, she doesn't know him"

Me: "She can't know we sent it, she would consider it a giant 'Up Yours from your good friends, the Peeps at the Health Center'. We should just do it anonymously"

Sherry: "Maybe you're right. We will know if she got the package only because she will probably be wearing the stuff next time she comes in"

Right.

As if to illustrate my point, this gem was heard on the police scanner:
"75 year old female with suicidal thoughts, X Elm St. apt 12. Called in by a neighbor residing at apt 14 who went to check on her". That would be none-other than the Lady on Elm St. She sits and waits. And knows exactly what is going on in the neighborhood, which is why sneaking up on her with a big box of Christmas presents would not work well.

A recent meeting about the Lady on Elm St. revealed that she is more vigilant (and crazy) than we ever thought. It is important to note that the meeting was not for planning how to best address Lady's needs or to provide better care. It was conducted by Idiots in Charge of Stupid Sh*t so that we drooling morons who actually provide the care could "express our feelings".

Isn't that what blogs are for?

Lady reported to have used 911 over 100 times in the last calendar year, including 7 times in one day for nonsensical complaints. She also has Patient Services on speed dial since she had logged 23 complaints in the last 18 months.The Patient Services rep. is the proud recipient of her very own Lady complaint since she had apparently also failed to take Lady's call right away one time. As Lady didn't feel her earth-shatteringly dire complaint wasn't accorded the instantaneous attention she felt it
deserved, she immediately called the CEO's office. Said rep was summoned to explain why Lady's call was being so rudely ignored.

I can just hear the complaint now. "You people did WHAT??! You sent a box of slippers, nightgowns and sweatpants?? How could you be so rude and insensitive!".

Another Great WTF Moment

2011-12-16T23:55:00.000-05:00

I was removing sutures on a patient's index finger. Mac, who is famous for using running sutures (that I don't want to fu*k with) had fortunately only placed regular old interrupted sutures, but there were a lot of them. The patient happened to be a pilot, and he marveled that my old and decrepit eyes could see them let alone remove them so expeditiously.

Pilot: "I've been noticing that I have been having more difficulty with seeing things. Sometimes on approach, things don't always seem that clear so I have to rely on instruments"
Me: "Captain, that is the kind of sh*t the public doesn't want to hear". Seriously?

Which airline was that?

Secure. The. Manger

2011-12-07T22:35:00.024-05:00

Gil was apparently doing some cleaning around the homestead and offered his Nativity set to the department to display this Christmas season. Christmas. I said Christmas. CHRISTMAS!!!! It's a religious hospital so we don't have to be politically correct.

Gil's Nativity set is a behemoth of a thing about 3 feet by 2 feet and stands about 18 inches high; it was hand made by his grandfather and has a nice, Christmas-in-the-backwoods-of-Maine kind of feel to it. It's rustic and....stable-like. And appopriately enclosed on three sides, with a slanted roof and filled with hay. It is kind of a family heirloom I guess, so I was concerned about its contents if it was to be placed in our waiting area.

You may recall that last year our own pathetic Nativity set was the victim of light fingered douche baggery as both the Jesus and Mary (pretty much the whole reason for the season) were purloined from our waiting room. Gil had already thought of that and had purchased a piece of Plexiglas to screw into the front of the manger to keep the pieces from being removed. As Gil prepared his tools, I examined this scheme for loopholes. While I was at it, I placed the Wise Men in the hay loft with the animals, and the Baby Jesus on the roof. As it should be. The only problem I could see was that once the Plexiglas went on, the figurines would not be secured. Nothing would prevent someone either shaking it like a Polaroid picture or knocking the whole thing off the table.

We shall see what kind of fu*kery people get up to with that Nativity set.

On another note, I am feeling a little less humbuggy as we nurses have decided against giving the docs a bottle of wine, or monogrammed bottle stopper or some shit this year. We will instead be giving a donation to the Wounded Warrior Project in the name of their physician's group.

Top 10 Christmas Annoyances

2011-12-06T18:43:00.003-05:00

10. Finding a tree.
I used to love to find the perfect tree when my kids were young. The perfect height, just the right amount of bushiness, and with branches that really hold both lights and heavy ornaments. As the kids got older and less interested in finding a tree let alone decorating it (and taking it down) it became more of a chore. I was almost ready to get a table top model this year, but settled for a 5 footer. It is more cute than magnificent, and I'm pleased as punch that it should take 30% fewer ornaments.
9.  The mall.
After Black Friday I go no where near the mall on weekends as it is absolute insanity. I prefer to shop local or cyber shop. If I get bored with that, I can just stick sharp needles in my eyes to get the same experience.
8. Charities.
I guess it is probably a wonderful thing to buy a llama, or a goat, or a small herd of chickens for villages in third world countries. If that is your thing, that's fine. But I would prefer to give my money to the locals. Until this year. See previous post on Christmas giving and don't get me started.
7. Finding a really good partridge in a pear tree.
You can always find a serviceable partridge, and a fine pear tree, but a nicely matched set...impossible.
6.  My neighbors' excessive Christmas Beast lights and lawn menagerie.
They have about 30 or 40 different things, it makes no sense and has no central theme. There are deer, snowmen, a train, some flashy thing I can't quite tell what it is, and...
"What's that?", I asked Mr. Ednurseasauras. "Second to the right of the blue snowman".
"Ummm...dunno. Does it have a cane and a red scarf?"
"Can't tell. Is it an....angel?"
"No. I think it's a bear (Gets up and looks out the window)
"Is it a goose?"
"Nope, it's just what I said. A bear with a red scarf, and either a cane or a stick."
"Why would it have a cane or a stick? That doesn't make any sense"
"Maybe it's doing a tap dance"
I don't know why I expect anything my neighbor does to make any sense.
5. Christmas Cards.
I don't send 'em, yet people inexplicably continue to send them to me. I'm not counting my family, not even one of my sisters-in-law whose goal is always that hers is the first card received. She sends them earlier and earlier each year. Now we get it the day before Thanksgiving. That's OK, I enjoy seeing the photos of my nieces and nephews and have them saved to embarrass them later. My own kids refused to pose for the annual Christmas photo when they were about 8 or 9, but a couple of years ago I put some Christmas lights on Tina and printed a Christmas card out of the photo which I sent to the family. My mother thought I had finally lost it.
4.  Having to work the holiday.
I get that nurses, along with police and fire and other public servants, have to work 24/7 and we all have to take a turn. What chaps my ass is that Clip-board nurses and Suits get to take an extra day off when Christmas  falls on a weekend
3.  Catalogs.
Really annoying since I get hundreds of them beginning in October. Because it is necessary to recycle, they must all go to the dump, to end up in appropriately coded bins. I am placing my recycle bin under the mailbox. No wonder the Postal service is going broke.
2.  Christmas Muzak
It starts in October, right around the same time I start getting the catalogs. For that matter, who wants to see Christmas decorations along side Halloween candy?
1. Christmas wreaths and reindeer antlers/red noses on cars.
This, to me, says, "I have more than enough time on my hands and absolutely no imagination". My friends think it is hysterical that this makes me so crazy. Linda and Dede gave me one of those antler thingies last year as a joke, but I put it on Sue's car. I hope she is presently enjoying it on her car as much as I enjoy not having it.

Christmas Giving

2011-12-05T20:06:00.134-05:00

During the holiday season, our building "adopts" a needy family. In past years we have shared this opportunity with the therapy department. It always includes some modest requests such as pajamas or a specific toy or two for the kids, perhaps a jacket, winter hats and gloves, jeans and other necessary items. Occasionally it will include such things as shampoo, soap, toilet paper. We always donate either gift cards or foods to provide the makings for Christmas dinner. The hospital provides the turkey to all the Christmas families.

Last year, it was decided that we would also donate gits and food items to one of the community's elder citizens. Slippers, nightwear, a sweater, gloves were some of the items. We found out that the recipient also had a cherished elderly cat so we included cat food.

I don't know how it went horribly wrong this year. We have not one, but THREE families, and no elder citizen. Each of these families has three kids, most of whom are teens. I would love to know how these families were screened or chosen.

Our employees started asking about the needs list weeks ago. It finally went up December 1 after it took 4 phone calls to one of the families to get sizes and specifics. FOUR. Sherry said that the husband talked about being suicidal during two of her calls. The list of wants and needs included such things as:
I-Pods
Ugg Boots
Abercrombie T shirts
4x pants
Leather gloves
Movies, a laptop computer, and a snowboard.

Really?? This has gotten completely out of hand. There is also the Christmas dinner to provide for with check-off sheets for each family; each of these lists is a full sheet of paper long. There are about 27 employees in the building, and most of us have been forced to curtail our own Christmas madness.

The Christmas project is a Big Deal to Ellen; she loves to provide as many needs as she can off the list, it gives her tremendous joy. But this year poor Ellen is beside herself. She took me aside and tearfully said she was having a lot of difficulty with the enormity of the list because she just didn't have the money to give this year. I know Ellen lives from paycheck to paycheck but she would never in a million years consider herself as a person in need of anything. She was proud that she managed to turn a jar of spare change into 23.98 when she found herself broke two days before payday and needed gas and a few groceries, and to buy stamps for her Christmas cards. She gives and gives and gives, and then she'll check the couch cushions for spare change so she can give more, using her last buck to buy flour to make cookies for someone's birthday. I stick a $20 in her purse every now when I think I can get away with it.

How can you tell such a giving person that these are less needs than demands? I don't care how needy you are, I would never ask for anything for myself if it meant that my kids would have to go without warm clothes, or a pair of boots, or have absolutely nothing under the tree. I used to think that any parent would think that way. What a chump I am. I guess it is what we have allowed as a society, to encourage people to grab for what they can with both hands. When it comes to Christmas giving the magic is gone when people who are identified as those being in need of the basic necessities of life have no problem shooting for the stars and hoping to land on the moon.

I haven't had a problem with the Christmas project before now, so I hope you'll excuse the humbug attitude this year. There is a BIG difference between "needs" and "gotta haves" when everyone else is tightening their belts. I guess I'm just a terrible person.

Cart-ashian

2011-12-01T22:33:00.000-05:00

Marketing refused to give up the ghost on their search for the elusive beige cart. This second appeal appeared on the company website:
"The Marketing Department has lost the Marketing cart somewhere within the hospital- have you seen it? I am totallyy lost without it. It is tan in color and says marketing on the side of it. If you can provide tips to the whereabouts of this cart, a warm fleece reward awaits you. Call me at ext. XXXXXX and I will gladly come and get it. Thanks!"

I believe "fleece" is also a name for counterfeit crack. Just sayin'. But it was nice that they were willing to heat it up.

We had a field day with this. Kate, Lee, Lynne, Kerry and I took pictures of various carts and emailed them to marketing over a couple of days. It took awhile for them to realize we were being humorous, but hey, they still think they're getting their cart back. "No, not our cart but thanks" was the response to images of the code cart (both adult and pedi), TV cart, suture cart, laundry cart and computer cart. I'm pretty sure it was the picture of the shopping cart that tipped them off, but it was surely the hot dog cart photo that pushed them over the edge. No response to that one.

Next week, we're going to start sending pictures of carts Photoshopped in places like the beach, bars, amusement parks, and the Statue of Liberty with interesting commentary on what an exciting time the cart is having instead of being cooped up in marketing. I think he best way to end it will be to open a Beige Marketing Cart Facebook page and friend the head of marketing. Too bad social media is blocked on hospital computers.

Snatch Purse

2011-11-25T23:49:00.002-05:00

Ellen was the one who cut the article out of the local paper. One of our frequent patients had been arrested for stealing money from her friend in the amount of $2000. She ran to a neighbor's garage where police recovered about $120 in a bottle of ant killer. Although she denied stealing any money, having any money on her person, or having any connection whatsoever with cash in the bottle she later copped to having hidden roughly $1,654 in her vagina. She was taken into police custody after turning the cash over to the police. Nasty.

This, of course, prompted a discussion of the possible denominations she had managed to secret upon her skanky person as we pondered the required capacity.

"'l'll bet it was 16 hundreds, 2 twenties, 1 ten and 4 ones"
"Maybe it was all in silver dollars"
"How about a Traveler's check?"
"Nah, it had to have been $1,654 ones."
"Gold doubloons!"

I am only using my debit card from now on. My mother is right, money is dirty.

Actual Dictation

2011-11-19T23:49:00.005-05:00

"Patient is a 23 year old female well nourished and well developed in no acute distress. She is a recent graduate from collagen but is seeking employment".

No doubt her job hunting is in the field of esthetics.

You Might Be a Squirrel If....

2011-11-18T22:00:00.005-05:00

1. Your husband gives your date of birth when I ask you for same along with the correct spelling of your last name as a patient identifier before I administer your meds, and
2.  He also assures me, as you describe you 10/10 pain, that you "have a really high pain threshold and tolerance to pain meds" and
3. I had to ask you to get off your cell phone when I  entered your darkened room.

The next guy
1. You are slumped dramatically in the chair and state you have "pain everywhere", you always have pain and that your foot injury from three weeks ago "brings tears to your eyes". Your foot injury that you never had checked, and
2. The only medication you can take is Dilaudid, your pain doctor only gives you a 'script for 12 at a time, you took your last Dilaudid yesterday, and
3. You didn't volunteer any of this; I had to pry it out of you, and
4.  Your pain is "15/10".

Happy Blogiversary to Me!

2011-11-17T22:30:00.007-05:00

Hard to believe it has been four years since I started this blog. Where has time gone?

What started out as rant/journal/self-expression/writing exercise has evolved into an empire: NY Times Best Seller, international acclaim and personal appearances, and now a lucrative movie deal. Actresses under consideration to play the role of EDNurseasauras are Glenn Close, Kathy Bates, Helen Mirren (with an American accent of course), and Olympia Dukakis. Those of you who know me personally may have some ideas.

Yeah, right. It amazes me that anyone actually reads any of this or that I haven't run out of things to say. Oh sure, I 've taken time off from time to time but have always come back.

And so have you, dear readers. I thank you.

Seriously

2011-11-11T00:59:00.000-05:00

I found this on the company website:
Marketing needs your help!! We are missing our beige pushcart that has the words "Marketing Department" written on the side of the cart. If you have seen this cart can you please return it to the "Marketing Department" on the ground floor next to the Credit Union or call XX at ext. XXXXX. Thanks.

Hey "Marketing Department":
Someone has "appropriated" your beige pushcart. It is not coming back anytime soon. Today the push cart, tomorrow your entire department. You suck. Get a clue.

On Gilding the Lily

2011-11-08T21:23:00.010-05:00

It doesn't take a genius to figure out the scammers. Drug seekers will often have an elaborate story, which just as often doesn't add up. Striving for the perfect combination of symptomatology and believability that will yield a score takes talent and experience. The newbies are spotted a mile away.

One misguided very young female and her skievey male accomplice in search of the ever-elusive narcotic script said she had "blacked out" while at Subway 5 days ago. She had been taking Tylenol and Advil for her terrible headache ever since.

I backed up the bus. "Blacked out?"
Woman: "I was waiting to order. My head has been really hurting ever since"
Me: "Did you lose consciousness?"
Woman: "Yes. The top of my head is where it hurts. And I feel dizzy"
Me: "Did you hit your head?", "Did you go to the ER or see your doctor?"
Woman: "I was told I hit it on the counter. No, I didn't see doctor. I've been trying to take care of my really bad headache on my own. But I've had the headache for 5 days now non-stop"
Me: "Were you at all concerned about blacking out?"
Woman: "Not really. I'm more concerned about the headache"

Sigh. She answered yes to the presence of nausea, photophobia, lightheadedness, aversion to sound, having no appetite, and allergy to cats, bees, codeine, Tramadol, Imitrex (although she denied a history of migraines). She also reminded me three more times about her 9/10 headache.

See, she way overshot the mark here and simply added too much embellishment. Concern about "Blacking out" and head injury trumps persistent headache. This will not garner narcotics, but it WILL buy head CT.

Power Up

2011-11-05T12:12:00.003-04:00

It has been a rough week here in the northeastern US thanks to Snowtober, or the Hallow-easter. Snow before Halloween, what's up with that. Didn't care much that Trick or Treating was postponed since I didn't buy any candy, but I never get any kids anyway. The heavy snow caused downed trees, tree limbs and power lines snapped off, which shut down everything. Power outages have lasted anywhere from several hours to days, with varying levels of inconvenience Mine was out for 3 1/2 days, bad enough but not as awful as being without for 6 or 7 days. Still, 3 days of cold, powerless, flushless captivity can get the best of anyone. The generator was handy for running a little heater since our pellet stove was on the fritz, but is was mainly boredom and cold. I spent hours in my car driving around to nowhere in particular.

The building where I work has quite a nice shower available for use in the evenings and was quickly dubbed "the spa". The main topic under discussion at any gathering was, of course, power and the lack thereof.
Early in the week, the questions were ordered thus:
1. "Do you have power?" 2. "Do you have a generator?". 3. "Do you have heat?
Mid week:
1. "Did you lose power?" 2. "When did you get it back?" 3. "Do you have a generator?"
Late in the week:
1. "Still no power?" 2. "When are you buying a generator?"
After day 7 without power:
"You must be really pissed".

Ah, the generator. A household must that never crossed my mind to procure before I moved to the Frozen Tundra. When it comes to generators, there is an order of supremacy. First, there are the "haves" and the "have-nots". People without generators are the have-nots, pitiful souls at the mercy of the elements, doomed to move to a hotel or worse, the in laws. Those with the foresight and just plain good old Yankee common sense and Boy Scout-level of preparedness...well, obviously those are the haves. As in having heat, water and flush toilets, a fridge, some lights, a way to charge the cell phone, DVD's for the kiddies who can't read or otherwise haven't the first clue on how to entertain themselves, and maybe even....the Internet".
(cue Angelic choir and Heavenly light).

It is not enough simply to OWN a generator,but rather how big it is and how it is utilized. There is Generator Envy, the bigger and more powerful the better. It is a guy thing. Like cars, which I don't care about.

The top of the line, Whole House generator (again, cue Angelic choir and Heavenly light) apparently requires only an insignificant flick of a switch and presto! You have power without skipping a beat. It is pretty pricey, the top dog for generator supremacy.

Many people go for the less expensive option, the portable, gasoline powered generator in order to plug a few extension cords. It works just fine. The problem with a gas-powered generator, we discovered, is that in a widespread power outage GAS IS INACCESSIBLE BECAUSE IT REQUIRES POWER TO PUMP GAS.

There are alternative fuel sources like natural gas. Mr. Ednurseasauras had already scheduled an electrician to install a transfer switch in the basement so that 6 or 7 different electrical...things... could be run off the generator without using 20 extension cords. Unfortunately, it was scheduled for the day after we got our power back, but hey, we are all set if it happens again. That, and the 40 gallons of gas he plans to have just in case.

Of course, turning on the generator with this new set up could be dicey. When the electrician left, Mr. Ednursesauras wanted to show me how to run it....just in case.
Me: "Nah, I don't want to learn right now"
Mr. EdN: "It's easy"
Me: "Yeah, right that's what you said about turning off the generator. As I recall, you also said that about the snow blower"

I am envisioning two sets of launch codes, confirmation codes, a variety of pre-launch procedures and checklists,and simultaneous turning of identical keys to get the generator started. After confirming, of course, that the power outage is genuine and not simply a drill.

Cry Me a River

2011-11-04T23:59:00.001-04:00

I don't mind people using the Internet to look stuff up except when they are too stupid to use the information correctly, then try to tell me I'M the idiot.

Ms. Dumass: "I have a severe lacrimation*"
Me: "You have....watery eyes?"
Ms. Dumass: "No! Don't you know medical terminology?? I have a bad cut on my foot!"
Me: "Ah, I apologize. I thought you said 'severe lacrimation'"
Ms. Dumass: "Yes, of course, that's what I said, a lacrimation!"

Some days it's just not worth bothering to try to educate nasty people who are dumber than a box of rocks. Please don't use big words you don't understand, it merely serves to emphasize your stupidity. Thank you.

*For non-medical types, that would be an excessive secretion of tears. Cut=laceration. So very dissimilar.

Cautionary Tale

2011-10-31T22:55:00.007-04:00

It's fine to help your kids with their science projects, but that doesn't mean doing it for them.

Mom cut herself with a pair of scissors while cutting a twig so the 12 year old wouldn't. Why she needed to use the scissors in the first place was beyond me since the project entailed creating a primitive tool. I don't think primitive people used scissors to fashion tools.

As she received 5 sutures mom commented: "We better get an A on this project".

WTF? I never got a lot of help on my projects from my parents except to cart it to and from school. Unless it involved power tools, then I wasn't allowed to use the chain saw. Lame Styrofoam solar systems or exploding volcanoes were otherwise my responsibility.

Once I had to do a working digestive system. I traced my little brother's outline on a piece of plywood, then filled in the esophagus, stomach, intestines etcetera. My dad drew a profile (face only) of Lucy (Peanuts Lucy, not I Love Lucy...although THAT would have been interesting). My little brother was upset that I put Lucy on his body but he got over it. I got some plastic tubing that I stapled gingerly on the plywood being careful not to poke holes in it. Thus I was able to demonstrate the fascinating journey of food, using Kool-Aid, through the body from start to finish. Everyone thought it was gross, but that's fourth grade for you. I got an A on the project. "We" didn't get an A.

Got Flu for You

2011-10-30T22:05:00.007-04:00

It's official: "Go directly to the ER at the first sign of flu" season is upon us.

One guy wasn't feeling great, "felt warm" (um, his thermometer didn't work), kinda tired, and had a sore arm because he had a flu shot yesterday. Perfectly healthy guy. Came from work. Home with common sense generic remedies. I think the CDC should start keeping statistics on ManFlu.

I did three flu swabs today, and not a single one was positive. Nobody was sick enough for the ER, trust me.

One mother of a 6 year old called first to make sure we did flu tests and we could give her kid Tamiflu if needed. Yes to the test, no to the Tamiflu. We don't stock it, and the pharmacies are closed now. Call your pediatrician for flu guidelines, no I can't say whether we will or will not give it to your kid anyway. The advice she ignored. The kid wasn't really sick other than a low grade fever. He was otherwise healthy. But he did have a birthday in a few days and mom's goal was that she wanted him healthy for the party.

Negative flu test. No Tamiflu. Cancel the party.

Being Nosy

2011-10-29T21:59:00.005-04:00

A three year old little girl was brought in by mom. "She stuck something up her nose"

Tonight's foreign body was a little piece of plastic that came out with relative ease. I always have some fun with this kind of thing. Sometimes the parents know what the object might be, sometimes not. .

Here are a few examples of the responses I have gotten when I asked the kiddo WHAT was up nose:
"An eraser!"
"Kleenex!"
"A Barbie shoe!"
"Playdoh!"
"A cat treat!"
"A flower! I was smelling it and it just stuck there!"
"Nothing! Just boogers!"

I trust you have seen the image of the little girl who suffered for years with recurrent sinus problems who, it turns out, had a safety pin lodged up there in her sinus cavity. Google "girl with safety pin in nose" to see it, I'm too lazy to post a link. It's an impressive example of the kinds of shenanigans kids can get up to when you turn your back on them for like, 2 seconds. When I was a school nurse one of my favorite kindergarten teachers brought two adorable little 5 year olds fresh from the playground.

Mrs. J: "Lacey, tell Mrs. EdN why we came to see her today"
Lacey: "I put a pebble up my nose!"
Me: (coughing to hide a laugh) "Lacey, how come you put a pebble in your nose?"
Lacey: "'Cause it was little!"
Mrs. J: "Now, Gina, will you please tell Mrs. EdN why we came to see her?"
Gina: "I put a pebble up my nose too! I was showing Mrs. J. how Lacey did it!"
Me: (really, really trying not to laugh but really, really not succeeding) "Oh, I understand. So the pebbles are still stuck up your nose?"
Lacey: "No, mine came out!"
Gina: "Mine fell out when I sneezed!"
Me: "Well that's good. Let me just look and make sure, then I'll call your moms. No more anything up the nose though, right girls?"
Lacey and Gina: (in little sing-song voices) "Noooooooo!!
Mrs. J: "And why don't we want to put anything up our nose?"
Lacey and Gina: "Because it's BAAAAAAAAD!!!"

Definitely everything we need to know we learned in kindergarten, sometimes the hard way.

The Long and Short

2011-10-28T20:53:00.000-04:00

Whenever a patient says, "...to make a long story short", I know I should probably get a snack and settle in becuase it will be anything but short.

Mr. Yada: "Well it all started 2 weeks ago......blah blah fever 1 0 days ago....blah blah.....urinary/prostate problem....saw my primary care...blah blah yada yada....testicles hurt.....mumble snort.....pain when I urinate.....yada yada blabity blabity blabity yada...."

He went on for 10 minutes in spite of my attempts to pry the Reader's Digest abridged version out of him.

Me: "So, sir, to summarize, you have had intermittent fever for 10 days, testicular pain and swelling for 5 days, and urinary symptoms for 4 days? Is that correct?"

Mr. Yada: " Um....yes, I would say that sums it up nicely. How did you do that?"

Me: "Active listening and a scary ability to condense".

Opiate Entrepreneur (def):

2011-10-26T19:52:00.000-04:00

(n) individual with an unreasonable number of ER visits for bogus medical complaints, frequently involving improbable, nonsensical, or fictitious injuries causing severe unrealistic pain who seeks narcotics for the purpose of resale. See also: squirrel.

This is nothing new except they are more aggressive and are more likely to get what they want thanks to hospital mandates on patient satisfaction. This is behavior what turns ER nurses cynical and suspicious. The docs see these people ocasionally; the nurses work every day and can usually recall at least a couple of their visits. Today I had 6 of them within 2 hours. What they had in common:

1. More than 12 visits each for pain-related complaints
2. No job.
3. No insurance
4. No ID
5. No credibility
6. No intention to pay anything for the visit.
7. They left empty handed

Just...No

2011-10-25T02:01:00.020-04:00

I am not really a girly girl, but I do like to get my nails done every couple of weeks and indulge in a pedicure every 5 or 6 weeks; maybe more often in the warmer months. Hey, I deserve it. I walk my dog every day and spend 8 hours on my feet at minimum. You only get two feet.

I have been going to my present salon for nearly 7 years. I am not all that fussy about who does them because they all know what they are doing. Plus they can always fit me in the same day, which is good.

There is a TV in the salon; it is always on. When I first started going there, it was constant music videos, the owners favoirites being concerts of the Eagles, Celine Dion, Tina Turner, ABBA, and, oddly, J Lo. I have heard all of these many times. When they got a bigger TV it was movies for awhile. Now, it is daytime talk shows and soaps, CNN, reruns of The Golden Girls and other boring stuff depending on what time of day I hit the salon. It is generally quiet and calm, low conversation and the staff not overly chatty. Just the way I like it.

Today I stepped into a Bizarro World; a new nail tech flirted shamelessly with one of the male technicians. One woman shrieked into her cell phone incessantly (you know how I love that). A whiny woman complained about the smell of acetone (seriously?? WTF did you expect in a nail salon, moron?). Worse still was a man and wife duo getting pedicures and talking about the benefits of cosmetic surgery while "The Replacement Killers" movie was on TV. So NOT relaxing.

What's the world coming to? Next time it will probably be "Kill Bill", with the odor of acetone replaced with Old Spice. If this turns into a men's nail salon, I'm outa here.

If He Could Only Go Back in Time

2011-10-24T21:31:00.001-04:00

It has been at least three months since I have had to work with Bobo and I can't say I've missed the little twerp in the slightest. Since he is the antithesis of team player he is always such a pleasure to work with.  Especially annoying is that he is still like a rabid squirrel on the 20 minute or less door-to-doc time.

Most of the time the patients see the physician within the allotted (and heavily marketed) time frame. Mostly the delay lies in the minor detail of the registration process as it is unwieldy and takes a ton of time. There used to be two registration clerks, but  the Brain Trust that is administration actually cut secretarial hours after 3 PM so now there is only one until 7 PM when outpatient services close. Brilliant. This has resulted in ridiculous waits for the appointment-making and insurance-having outpatients as well as walk-in routine blood draws.  On 3-11 it can get pretty busy since both the ER and outpatient department business picks up.  It doesn't help that a couple of the secretaries are deadly sloooooow. Thorough, but slow. There is apparently no way for the Suits to speed up this process although I know it is MUCH faster at Pseudocity Hospital. Probably faster at any hospital that has a vision of rapid registration as a simple but effective means of improving satisfaction scores. But that would just make sense, what do I know.

So to recap, patients are triaged promptly but often fall down the rabbit hole of registration. That gets Bobo's tighty whities in a wad. He used to say is was because the nurses were taking too long to triage. WTF? I wasn't taking that lying down, so I began adding the time "triage competed" boldly next to the triage time. In most cases it was less than 5 minutes. He probably noticed that I only did this when he was working, and that I had instigated the other nurses to do the same. Thus endeth the discussion of how long nurses take to triage. But did it do anything to speed up registration? Um, no. I learned to make copies of complicated med lists for the above average patient who came equipped with such because we must HAND WRITE med lists or we get dinged, another stupid time waster.

Some of the other docs fail to write down the times of their first interaction with the patient and leave it to the nurses. It is usually a guess as we are also responsible for noting the following in addition to triage time: time to room, time physician sees patient, time of labs, xrays, EKG's and discharges in addition to the obvious like meds given, IV starts, vital signs, pain scale, blah, blah, blah.   I've mentioned that Bobo obsessively writes his own times down, and gets testy if we fail to write down time to room.   I think he gets a prize for having the fastest door-to-doc times, even if it means going out to triage and seeing the patient first if the nurses are in the middle of something he can't drag us away from. I have occasionally found him in triage if we are especially busy, so that his time-to-patient is earlier than the triage time. I don't think he has realized that this doesn't help his numbers at all as "door" time is calculated as "triage" time; the system won't calculate a minus. It also doesn't take into consideration that there is sometimes as much as a 20 minute wait for triage.

Last night I thought Bobo would have a stroke.  There were sick and complicated patients, multiple admissions and transfers, endless phone calls ("You have asked me to make 3 phone calls, start 2 IV's, and splint a kid; which would you like me to do first?"), the death of an end stage liver patient who's family was in denial which entailed even more calls and tied up a room for 3 hours (with the ER wake/viewing), and one nurse-accompanied transfer necessitating calling our boss in to cover for an hour.

Notice to all the non-urgents in the waiting room who expected rapid service: due to circumstances and Actual Emergencies beyond our control, 20 minute door-to-doc is suspended for the evening.

You Might Be Having a Bad Day If.....

2011-10-23T01:57:00.000-04:00

....you are burned by falling "into" a bonfire. While you are wearing spiked heals and drinking tequila
....you get into a car accident while enroute to the ER. With a tick bite.
....you are fake-vomiting into the toilet (ie, sound effects and spitting). Then your brand new I phone falls in.
...."you just can't get hold of" your doctor and you need an emergent narcotic refill. He is here in the ER and says he fired you a year ago.
....your friend pierced your navel for you after you were forbidden to have it done. You are not 18 for another week and we need parental permission to treat you for that infection.
...you come into the ER for back pain so bad you needed to be out of work today and will need to be out for the weekend. I did not triage you. But you did wait on me at the drive-up window at Dunkin' Donuts about an hour ago. Nice to see you again.
...your dog is startled by a cat and bolts, you pulled off your feet, and your head hits a rock. You are 71 and have a fractured skull.

Which one is the worst Bad Day?

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

2011-10-22T23:20:00.019-04:00

.......was a 32 year old male who just wanted to ask a question about whether or not he should be seen, thus incurring an ER charge. His 5 day old tattoo was looking a little red and swollen even though he had scrupulously treated it as directed by his tattoo artist with A&D ointment.

Here is a teachable moment: as always, if you are already in my ER and "just want an opinion if I should be seen", the answer is, with few exceptions, yes. Liability. Even if it is for a stupid reason. This was not a stupid reason, and he did have an infection. Antibiotics.

Interesting conversation overheard between the patient and Cripes:
Tattoo guy: "Yeah, I have some tattoos so I know how they should be treated. The place I go is really clean and uses all sterile stuff. I've never gotten an infection before"
Cripes: "Well, it's good you came in"
Tattoo guy: "I have been getting a few tattoos over the last couple of years. I used get piercings when I was younger but I've found that tattoos are more socially acceptable than piercings, more main-stream, ya know? You're more likely to find business people with tats, see. I work a lot with the public"
Cripes: "Oh, what do you do?"
Tattoo guy: "Auto salvage. And I have quite a car collection. Are you a car guy, Doc? What do you drive?"
Cripes: "Oh, I have a Tundra"
Tattoo guy: "I have a 1945 Blah, a 1957 Blah Blah, a sweet 1960 Blah Blah Blah a..." (he listed about 6 more classic cars).

I don't know, like, or care about cars. Someone talks about cars or golf and I start doing the multiplication tables in my head or fake a seizure. Booooooooooooooooooooooring. But I did think the guy's take on the social implications of piercings....insightful.

PS Aren't you dying to know what kind of tattoo he had?

It was a a horse. Ya know, like on those sports cars?

Found on the Bathroom Bulletin Board

2011-10-20T22:20:00.000-04:00

My religious hospital is always having some kind of fund raiser, asking for money, donations of time, collecting for Christmas baskets and back-to-school-backpacks, food pantries, the Lenten diaper drive, soliciting for nine different kinds of cancer, Sister Mary Clarence's beer fund, inner city victory gardens, windmills over Holland, employees with acute need, orphans in third world countries, etc, etc, etc. It is something every single week, literally. For a non-profit, they seem to want to squeeze every last penny out of the people who work there. I pick my battles and one or two things a year. I prefer to choose my own charities mostly.

So as I perused the Potty Notes, I came across this interesting nugget:

"Collecting Items for the Homless (sic)"

sweatshirts
toiletries
sleeping bags
tents
socks
hats
shirts
sweatpants
blankets
crockpots

Crockpots? Ooooooooooooookay!

Keep Honking, I'm Reloading

2011-10-17T22:30:00.027-04:00

Many of the Really Sick walk in. That is what we are there for, we are the closest help for evaluation/treatment/stabilization and transfer to a tertiary care facility. Sometimes, people who somehow manage to get themselves into a car will subsequently have difficulty getting out, due either to confusion or firmly held beliefs about when it is and is not appropriate to call 911. This is a behaviour peculiar to many an older adult, but is rampant among the Old Yankee population. A penny saved is a penny earned; if I can breath, I can walk; if it ain't cut off, it's only a flesh wound.

Sometimes family members will simply request a wheelchair. Sometimes they will come in and calmly request assistance, and we will trudge into the parking lot regardless of rain, snow, sleet or dark of night. But when there are only two of us nurses to tote that barge and lift that bale it can be a strain on the back; we are not superhuman. And we are none of us spring chicks. The youngest of us is 42. The eldest is......well, me, with three of my colleagues within a couple of years. Lab and xray on the evening shift? Same boat. The docs? Again, same boat. Gil already has a couple of stents, and though younger, Bobo is downright fragile.

We used to have an elderly post stroke lady who could barely walk who would to beeeeeeeeeeeep her car horn incessantly so we could come out and drag inside her equally mobility-challenged and even older husband by wheelchair for a catheter change. That was a treat. I think that was Second in Commands doing: "Sure, just beep the horn! We have curb service!". Not. I think he died or is in a nursing home.

When patients comes into the ambulance bay laying on the horn, though, we pay attention. Recent treks to the parking lot for assistance include:
"She's having a seizure"
"My husband has severe pain"
"My mother is short of breath"
"My daughter can't move her leg"

As for the above, none of them were exactly as advertised, and turned out to be more of a panic situation than anything life threatening. Seizure? Tremors in a Parkinson's patient who was either under-dosed or had missed their Sinemet. Severe pain? OK, that one was kidney stone, painful and scary; way more painful in men than women. Or more common anyway. Short of breath? COPD, always short of breath and still smokes. Daughter who couldn't move her leg? Soccer playing teenage girl. Drama, drama, drama. I usually make a bet that the teen will be on her cell phone within 5 minutes, and that at the conclusion of the visit she will hop up from her death bed and miraculously walk. Nobody will take my bet anymore because I am always right. The mechanism of injury is never commensurate with the level of disability portrayed. Also, they are uniformly poor actresses.

People in an absolute panic get pissed when ER nurses don't exhibit the same level of panic. They think that by remaining calm and in control we are complacent and uncaring. Really? Do do you think anything will get accomplished if I am jumping up and down screaming? Seriously? I will get out the Dope Slap machine and set it to stun if necessary.

And, although I operate on the principle that it is not time to panic until it's time to panic, once in a while someone will get my adrenaline pumping.

BEEEEEEEEEEEEEEEEEEEEEEEP! BEEEEEEP! BEEEEEP! BEEEEEEEEEEEEEEEP!!!!

New Cathy and I beheld an enormous SUV, engine still running, stopped diagonally across our ambulance bay and blocking the parking lot entrance because it was attached to a large trailer. The trailer was partially in the street. The 70ish man in the driver's seat was pale and sweaty and breathing rapidly. Wow, I thought. He's having the Big One. "Sir, what's wrong? Are you having pain? Are you diabetic?"

"Call. The police. Secure. The guns."

WTF? Guns?

I reached in, put the car in park and turned off the engine lest we be run over. New Cathy and I hauled him into the wheelchair (he could, fortunately, briefly stand). All the while he muttered, "Secure. The guns. I. Have a. License. Legal. Need to. Lock. Them. Up".

He was diabetic, had a cardiac history, and was dehydrated having driven most of the day from some gun show. He wasn't having the Big One that day, but he was admitted anyway.

The guns? All legal. The local police came over to move the SUV and secure the weapons, locking them up at the station. BEEEEEEEEEEEEEEEEEEEEEEEEEEP!!!!

Just a Thought

2011-10-15T22:19:00.004-04:00

I pass by a local church daily on my way to work. For days and days parishoners with heavy equipment worked on extending their parking lot by excavating a hill. After endless grading and preparation, it was ready for asphalt.

I envisioned a sign for the project:
"Jesus Paves".

Darwinism...

2011-10-14T22:33:00.003-04:00

......the process by which, via natural selection, unfit specimens remove themselves from the gene pool

A few candidates who are genetically hanging by a thread for your entertainment. There will be a quiz at the conclusion of this presentation:

A. 40 year old man came in complaining of "really bad burns". He had been at a local bonfire/pep rally or some crap, and was tending to the fire. He had some 1st and 2nd degree burns on his right hand and arm, and the backs of both legs.

Me: "How did this happen?"
Guy: "I threw some gasoline on the fire"
Me: (blurted before I could stop myself), "WHY??"

Did I mention that he had three or four kids under the age of 12 with him? Um, yeah.

B. 33 year old who used heroin for the first time. At work. That's all I have to say about that.

C. 42 year old who had a couple of beers at lunch and went back to work. As a roofer. Using a nail gun, he buried a couple of inches metal into his proximal femur. THIS CLOSE to his femoral artery

D. 36 year old nearly removed his own knee cap with a chain saw. He admitted to taking a "butt load" of oxy's daily for his chronic pain condition for which he is disabled. Let me also mention he weighed over 300 pounds and had stopped at Burger World (as evidenced by paper sack he was toting) and had a blood pressure of Patent Pending/100. A more cynical person than I might wonder how in hell he imagined using a chain saw in his debilitated condition was a good decision.

Which of the following statements is true: (I told you there would be a quiz)

1. They are all men
2. They have all made galactically stupid decisions
3. Antibiotics cure viruses.

A. 1 & 2 only
B. All of the above
C. 1 & 3.
D. None of the above

On Falling

2011-10-11T21:50:00.007-04:00

I was asked to cover a couple of hours for Kerry on a day off so she could go to a meeting, or buy chickens or something; sure! 2 hours=1/2 of a princess shift.

I took care of only one (one! ONE!) patient for 2 hours and 20 minutes. Young. No job, no insurance and had applied for Medicaid when she found out she was pregnant; I don't know why she wasn't already on it since she had only one arm, a congenital condition. She seemed like someone who had, or would soon be, falling through the cracks.

She didn't know what to do: she was by herself and scared. She had just had a "screening" ultrasound at a free clinic during her first pre-natal visit; her baby had stopped growing and had no heartbeat, she said. She did not know what to do next since she wasn't bleeding or cramping. The clinic kicked her to the curb with some phone numbers. She was worried about the cost.

We did the usual blood tests and an ultrasound that confirmed fetal demise at about 8 weeks gestation. Twins. I arranged an appointment for her that very afternoon with the OB to discuss her options. She elected not to keep it because she had to get home so her boyfriend could get to school. I tried very hard to get her to change her mind

"I guess everything happens for a reason", she said. "It would have been almost impossible with one baby, let alone two".

I made two phone calls to her over the weekend which went unanswered. She didn't call either.

The next sound you hear will be someone falling through the cracks.

Planning

2011-10-06T21:29:00.004-04:00

The 93 year old cardiac arrest rolled in without advanced airway or IV access. No drugs. Asystole. CPR was halfheartedly in progress. The young man who had found her on the floor was living in the house, a friend of the patient's great grandson. The patient was supposed to be DNR. Why, then, was she in our ER? The young man called 911 in a panic, and could not produce the DNR or any documentation. Since none of the actual family members were at home, CPR was initiated by EMS. She was pronounced dead moments after her arrival in the ER since she had an advanced directive on file and the family member called us. Good; we didn't have go all out on the Poor Dear, and the end of life wishes not to be kept alive by artificial means were (sort of) followed.

Note to self and others: discuss end of life plans. Have one in place. Keep the DNR handy. If there is a terminal illness, understand what to do if the family member dies at home. This was a case of good intentions, just a tad short on follow through.

It fascinates me that although death is inevitable, so few families are prepared for it. We don't often discuss it. Terminal illness aside, it seems as if by ignoring the Reaper, he will ignore us.

I can't stress this enough. Everyone deserves to be treated with dignity, yet there is little dignity when an elder loved one dies in an ER, worse still when it isn't their wish to be kept alive with heroic measures. I would hate to have my last image of a loved one lying lifeless in an ER.

Squirrel Count

2011-10-04T21:52:00.003-04:00

I love Gil. Some of the other nurses thinks he orders too many tests, but I don't. He likes taking good care of patients, likes to educate, and always has something interesting to share. Having worked with him for about 2 1/2 years we've come to know him will. He used to be a little hyper, but he's over it. We talked about that the other day.
Gil: "I remember when I first started here, I was kind of ramped up. At least you guys know when I need a time out".
Me: "Yeah, the first few months were....challenging at times. Not that you weren't likable, that wasn't the problem. And it wasn't a time out you needed: a couple of times I just wanted to slap the shit out of you. Calm. I like calm and focus. Breath in, breath out. This is not Chicken Little ER".
Gil: "Always some bumps in the road with new docs, huh?"
Me: "Mmmmmhmmmmmmmmm".

Loe the guy, but he's a squirrel feeder.

"If you feed the squirrels, they will keep coming back". This refers to narcotic seeking individuals. Gil's solution is to give them, say, 2 Percocet to go and no prescription. He may think he has shut off the squirrels, but he is still giving them acorns even if it's one at a time. Besides, it just makes us nurses have to sign them out, put them in a little envelope, and write "one tablet every 4-6 hours as needed for the severe, excruciating and debilitating pain that has brought you to the ER like 20 times this year. This is all you get, don't ask for more". Well, not the last part. Anyway, Gil just keeps on feeding those squirrels. Last night's squirrel count as follows:

Case 1:
Complaint: Butt pain
Goal: Narcotics
Plan: Home with narcotics
Female with a bruised butt from a fall down the stairs presenting with 20/10 pain on a scale where 10 is the max. So bad she took Tylenol about 20 minutes before arriving. She was observed on camera as she walked normally to the door where she then proceded to mmmmmmmmmmmooooooooooovvvvvvvvvvvveeee iinnnnnnnnnnnnnnnnnnn sssssssssssssllllooooooooooooooooooooowwwwwwwwwwww mmmmmmmmmmmmmooooooootion. Really. It was like a 78 RPM record being played at 33 RPM. And if you don't have any idea what I am talking about, ask your......grandfather. After she got what she came in for, her gait was back to speed as observed on our trusty Spy Cam. I would be so sad if that stopped working. Very entertaining.

Case 2:
Complaint: Back pain
Goal: Narcotics
Plan: Home with narcotics
Another young female who had been treated for sciatica and dental pain in 4 visits to the ER this month and had received Percocet for each of those visits.

Case 3:
Complaint: Acute knee pain. I had to get her out of the car 'cause she couldn't walk
Goal: Pain relief, rule out fracture, and not to have to use crutches
Plan: Home with narcotic pain 'script and crutches.
This one was a middle aged woman who thought karma was working against her as she had said just yesterday that she would never use a walker. Hah. People make plans, the universe laughs. We were completely out of knee immobilizers so I wrapped an ace bandage and gave her crutches. I worked with her for 20 minutes but at the end of the session she said, "I'm not going to use them anyway". Observed via Spy Cam walking normally in parking lot with the crutch tips pointing to Heaven.

Case 4:
Complaint: Man-cold with sore throat. Oh, and back pain.
Goal: Narcotics and work note.
Plan: Home with Tramadol and work note.
Don't get me started on man-cold. It is the season for most men to become a quivering puddle of sniffling, whining, hacking, helpless, miserableness. "I don't feeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeel goooooooooooood!" Percocet for a cold and sore throat of 4 hours?? Seriously? Are you fu*king out of your mind?

Here's an aside: a friend of mine who works in Endoscopy (AKA, the Bum-Lookup nurse) says that thanks to Michael Jackson's doctor, they are required to tell patent's that they will not be getting Propofol. Thank you.

Get Off the Phone

2011-09-24T19:29:00.010-04:00

I may put on a happy face in triage, but when things get ugly I can take it right back off. Nothing ticks me off more than people who just can't put down the fu**ing cell phone. So sorry to interrupt your oh-so-important text messaging so that I may triage YOUR emergent ER visit for say, dental pain or rash. Fever of 99.4 ("My normal temperature is 97.5, so that is BURNING UP for me!")

Me: "Hi, what can we do for you today?"
Loser: (continues with phone texting activities and doesn't respond)
I waited exactly 7 seconds.
Me: "Excuse me". I walked out of triage. I was really busy, so I made her wait awhile.
When I eventually went back in, I said "Are we all done updating the Facebook status?"
If they are too stupid to know they are rude, it is unlikely they will notice if I am....annoyed.

I do not sit in a triage room eagerly awaiting your visit. I have other patients upon which to do EKG's, clean wounds, and start interventions along with myriad other technical, secretarial and janitorial tasks (beds don't make themselves, and I certainly don't mind emptying trash and linen when it is overflowing). There may even be one or two patients with ACTUAL EMERGENCIES for whom it may be necessary to transfer out in a hurry.

I shouldn't have to tell people to shut off their damn phone, but common courtesy is non-existent. Hell, MANNERS are non-existent. Parents certainly aren't teaching the basics at home, and teachers are too busy just trying to get the little shits to sit in their seats without damaging their fragile self-esteem. Don't get me started on HATS. The last time I was at a public event where the National Anthem was played, the announcer actually told men to remove their hats. Pathetic.

I never never encourage people to answer their cell phone in my presence in fact I just don't even acknowledge their moronic ring tone. Like the Rocky theme. If it is a teen or a kid playing a video game I tell them to put it away.

What happened to respectful human interaction?

Gone by the wayside:
1. Saying please, thank you, and excuse me.
2. Waiting your turn.
3. Making eye contact
4. Teaching kids to have respect
5. Taking responsibility for your actions

Thus ends today's rant.

Feed Me

2011-09-23T23:17:00.002-04:00

You have 35 (WTF!) visits to our ER alone this year for migraine, I have no doubt that this is drug seeking.

Gil: "Well, I know he's here a lot. I'm suggesting that he make his own appointment at Up State Big Hospital, and keep a log of his migraine activity. I think he really does have migraines"

Me: "That makes one of you".

We nurses know who has had at least one visit per week, sometimes multiple visits in one day. We know all of your little dramas, which lies you have told, and when you park your car around back after telling us your ride will be "right along".

I dutifully prepare your dose of the "d" medicine after ascertaining that your usual cadre of medication allergies was unchanged. Toradol. Tramadol. Codeine. Phenergan. Imitrex. Fioricet.

Within seconds of the administration of your meds, your photophobia has resolved. You are a magically a different person and you try to engage me in a conversation about the Patriot's.  I get it; you really are just normal, friendly guy.

I'm sure you are. But I don't give you anything to work with. I'm sorry to be in a hurry to wrap this up as I have a vomiting 80 year old with an anxious family to deal with, as well as an infant with an uneducated single mother in need of teaching. You understand.  Neither you nor the doctor has any interest in addressing your addiction, we are rubber-stamping this visit and leaving it for the next person to handle. You have gotten what you wanted, so really, my time is better spent on caring for someone who actually wants help. Sorry, but that's the way it is. If you actually asked for help I would go the distance for you, and I mean that sincerely. But until you have burned all the bridges and hit rock bottom, there is little I can do. And it makes me feel like an ass each time you come in and play your little game.
Feeding squirrels. If you keep feeding them, they will surely return. What happens when the acorns run out?

Cuts and Cutting Remarks

2011-09-22T12:03:00.011-04:00

New Hampshire hospitals have been scrambling to come up with millions of dollars in budget shortfalls. The state legislature in its infinite wisdom voted to cut Medicaid reimbursements along with many other cuts to state and local agencies and programs. The impact to hospitals involves money that had been counted on during budget planning for the coming year, but now the rug has been pulled out from under.

The state taxes hospitals 5.5 percent on patient revenues, but returns the amount of the tax in matching federal Medicaid funds so they effectively lost no money. That's out now, and hospitals have been cutting jobs all summer, the latest round of layoffs occurring about a week ago.

We lost a number of positions, none of which were clip board personnel or Suits in Charge of Stupid Shit, not surprisingly. I get to keep my job. But there were several LPN's who lost their jobs. Just axed. Some genius in the public relations department of another hospital, who also cut their LPN's, justified cutting them since, "LPN's are really just glorified nursing assistants". Really?? Talk about adding insult to injury.

I have never worked in a hospital that employs LPN's in the ER, but I have worked with my fair share in many other areas. Some were good, some were great.

The first one I ever worked with was Mrs. Maccaione. I don't know if she had a first name, you either called her Mrs. Maccaione, or "Mac". In 1973 she had to be in her mid-sixties. Mac wore whites from the top of her starched cap to the polished perfection of her white Clinic shoes. She was as broad around as she was tall, and at 5 feet was an imposing and intimidating poster child for Crusty Old World War II Nurse. With her rolling bandy-legged gait and the whoosh! whoosh! of her pudgy thighs in their snow white support hose, she bore down on me and the other two nursing assistants like a ship under full sail; usually with guns a-blazing. She was NO NONSENSE in the flesh. She really did try and bounce quarters off of draw sheets. Mac was well known for her scrutiny of top sheets for precise hospital corners. Woe to you if you were caught resting a pillow under your chin to apply a pillow case. You would hear about it in spades if your patients weren't bathed in a timely manner or their immediate environment was not spotlessly clean. We were scared to death of her.

In the early 1970's, day surgery was non-existent. If you had a cholecystectomy or appendectomy, you were in the hospital for about a week. A tonsilectomy? Two nights. Wisdom teeth? That involved checking in to the hospital the night before your surgery and staying all day. Sometimes patients went home, sometimes they could "elect" to stay another night, like if they were vomiting or whatever.

Mac always greeted the patients and oriented them. This was a job that needed to be DONE RIGHT. She strode into the room and stood at parade rest.

"Good afternoon! Welcome to Unit F. I'm Mrs. Maccaione-call me Mac. You are scheduled for _____surgery tomorrow at 0800 hours. Today, you will be getting a visit from the anesthesiologist and having whatever testing may be deemed necessary, if any. You will be signing a surgical consent if you have not already done so. For today, you will be given a regular supper, served between 5 and 5:30 PM along with a light snack at approximately 8 PM. Visiting hours conclude at 8 PM, so plan accordingly. At this time, the switchboard will not put through any incoming phone calls to the rooms. Lights out in this unit is generally between 10 and 11 PM; you will be needing your rest. At 12 midnight, you will be NPO: Latin, Nothing By Mouth until after your surgery. You will be awakened at 5:45 AM to prepare you for your surgery. Questions?"

This monologue was delivered rapid-fire. I'm sure most patients didn't dare ask questions of Mac. Most of the doctors were scared of her.

But you should have seen her in action when it came to encouraging a fresh post-op and making them feel cared for. Or getting another 6 feet of corridor out of a tired newly ambulatory patient with a big belly wound (remember Scultetus binders?). There was nothing she couldn't get from the kitchen staff if she thought it would entice a finicky eater to take nourishment. For all her brusque and bossy affect she was a hell of a nurse; you would want her to take care of your family. I learned a hell of lot from her.

Just a "nursing assistant"? Oh, HELL no.

From Out of the Blue

2011-09-21T00:39:00.004-04:00

Sherry was curious about a little kid she had sent to the Big City Kid's Hospital with a forearm fracture from a few nights ago. We rarely get any follow up on people we transfer to other places unless we call them, or they have some kind of complaint or lost a slipper or some shit.

The parents, who were very, very anxious, were thrilled with the excellent care at Big City Kid's where he had a closed reduction under sedation. It was a long night, but he did well. They were also grateful for the care he had received at our facility. He was, however, almost out of pain medicine. Long story short, Cripes, who had seen the kid the other night was willing to write a 'script for the same pain medicine to tide the kid over for another day or two.

Dad came in to pick up the prescription and had this to say.

"Thank you for taking such good care of us the other night. You can't know everyone's story and what's gone on in their past. I just wanted you to know that how you treat people really does make a difference. Fifteen years ago, I had a son who didn't make it. I walked the halls at Big City Kid's. You remember the people, the doctor's and nurses, who reached out and tried to make a connection, a kind word. Some encouragement. Or helped us prepare for the worst. How you treat people matters. I was back walking the halls like I have for the last fifteen years. Thank you for caring about us".

I never cry at work. This made me cry.

Stop Bugging Me

2011-09-19T22:12:00.002-04:00

"I think I have a bug in my ear", said the guy in triage. "I was mowing my lawn and brushed against a rose bush and it feels like something is in my ear canal. I didn't dare poke it with a Q tip"

Good plan. Every time I get someone with a complaint like this, I think of the old Night Gallery episode hosted by that creepy guy Rod Serling. Some guy gets and earwig planted in his ear which then proceeds to munch its way through the brain (being unable to reverse direction), reducing the poor bastard to a shrieking mass of agony until it crawls out the other side. Whereupon the doctor informs him that it was, in fact, a female....which had laid eggs. Shudder. All of which is myth.

OK, I'm being dramatic.

So the guy wasn't having any particular difficulty while I was triaging. As I a walked him to registration, he freaked and started screaming.

"Ah!! Ahh!! AAAAAHHHHHHH!!! SOMETHING'S BITING ME IT'S BITING ME! AAAAAHHHHHHHHH!!"

I grabbed him by the t-shirt and dragged him into the nearest treatment room. Kate went to grab some lidocaine to immobilize whatever was in his ear. Suddenly, the guy stopped screaming and froze.

"It stopped".

No shit. "Let me see if I can see anything", I told him. As I pushed back his longish hair, I saw it: a GIANT Japanese beetle sitting in his outer ear. "Don't move for a second", I said. Trying not to either panic the guy or lose sight of the bug I reached for a glove or 4x4 gauze on the counter behind me. In the nanoecond I took to glance behind me, the beetle...was gone.

"Did you see anything? Is there anything there? Is it a bee? Did you get it?"

Shit. No, wait! There it is up on the very tip of his little, pointy elfen ear!

WHACK! I smacked the flap of his ear with my hand. Yes, I struck my patient. A first for me.

The beetle crawled on the floor unconcerned. I scooped it up with a wad of 4x4's.

"Oh, thankyouthankyouthankyou! You saved my life!"

Gil wandered in and wanted to know what all the shouting was about.

"This brave nurse saved my life! She got a beetle out of my ear, I thought I would go crazy! She's a genius"

Gil: "Oh, that's great! Did you use lidocaine?"

Me: "Nope. I just told it to go to the light, so it did"

Gil: "Hahaha!"

Two More Reasons to have a Crappy Attitude

2011-09-17T06:59:00.003-04:00

1. Mandatory flu shots, or wear a mask from December 1 to the end of March for every employee whether they work in a clinical area or not (note: the docs are not employed by the hospital). It's not that I object to getting a flu shot per se, I simply have a problem with authority.

2. My co-workers have decided to do the schedule through MID JANUARY, so as to get their holiday requests in. I can't stand it. I am boycotting the schedule until Halloween.

Genius

2011-09-16T12:15:00.007-04:00

I got a phone call from one of the adult overnight dormitory staff at Wicked Expensive Alternative Prep School around 9:00 PM. He wanted to know if it was appropriate to bring one of the boys for dental pain.

Sure, come on down. No, we don't have a dentist "on call". No, I have not idea what treatment he will get. Yes, he will be fully evaluated by the physician. No, I can't tell you how long the visit will be. Yes, we have some medicines available for patients to use until the pharmacy is open. Yes, in most cases we can call in a prescription provided you use a pharmacy that has an overnight answering machine. No, I do not have the power to order the pharmacist to open the store for you. Just get off the phone and get the kid here, huh?

Wicked Expensive Alternative Prep School has kids from all over the country and a large contingent of international students. There is a nurse who lives there, but I guess they give her a night off every once in a while. I think that along with the usual college prep courses, the kids are encouraged to pursue other interests not usually found at regular schools. Like, if they wanted to learn unicycling or something, or pottery, or start a social networking site or learn to juggle. Whatever, good for them to encourage independence and exploration. They are big on tapping into the genius of the faculty for ideas and guidance for their students' pursuits. I guess they figure the parents are paying enough money for the expertise, if they want to learn tie dyeing or candle making, fine.

Not impressed with the dorm guy, though. He forgot all the kid's paperwork that included parental permission to treat him. He wanted to know if we had someone on staff who could speak Mandarin (??). The very sweet young man spoke perfect English and oh, by the way, was KOREAN.

Does anyone but me find it disturbing that when he finished the registration process, the dorm guy wanted to know "where we put the Chinese kid?"

Bored I Guess

2011-09-15T23:23:00.001-04:00

For years and years I worked at least two and often three jobs at the same time, but at at least one was always in the ER. I have had lots of different experiences.  I've worked in schools, as a camp nurse, in home care, employee health, a travel clinic, a same day surgery unit, pediatrics, telemetry, and med surg. I have worked in large medical centers and community hospitals. I been a staff nurse, charge nurse, supervisor, director. I have done independent QA audits, worked for an agency. I have worked days, evenings, nights, weekends and holidays. I have worked from within walking distance to my job or traveled over and hour. I have worked with individuals who have become lifelong friends and others whose names I can't remember. I have been both student and a teacher. Sometimes I have felt unsure of myself and terrified, but have grown enough as a nurse to feel comfortable and competent, smart enough to know that I don't know everything. I have done a lot, seen a lot, learned a lot.

I  have been restless and not altogether happy with my job lately. For the last 3 years, it has been my only job. It is close to home and I work with a small group of nice, accommodating people in a small ER.

I have been thinking that maybe it is too small. I feel as though I am losing my skills as an ER nurse. Few codes, trauma as rare as hen's teeth. I am SO TIRED of the constant parade of drug seekers and the pressure to just make everyone happy, even if what they want isn't what they need. Want antibiotics for a virus? Sure! An Xray for your three week old ankle injury that you insist must be broken? No problem! Dilaudid for your migraine of 10 minutes? Absolutely! Why do you need doctors with experience and expertise when you have WebMD? All we ask in return is positive customer satisfaction scores.

I have never felt less valued as a professional nurse anywhere.  It's not my boss, she's great. It's the organization we work for. Our director talks a good game, but there is no visible support for the activities of nursing.  There is a part-time research nurse, nobody really knows what she does and I have never seen her. Committees? The same dull people with the same dull ideas.

I have a really crappy attitude and no real goals since finishing school. For the first time in a long time I have no concrete plans to move on, move up, or move out. Maybe it is because I am working only one job in a small town, I don't know.  I am in a real rut. I have to work about 10 more years until I can retire and that pisses me off. I can't see myself doing what I'm doing for another 10 years.

I keep telling myself I am lucky to have a job.

My Children of 9/11

2011-09-11T12:18:00.005-04:00

10 years ago I was working as a school nurse for the sixth graders' annual 5 day Nature Camp trip. This was always a fun experience for all, and highly anticipated by those of us fortunate enough to go. The week was carnival time for faculty, a "Get Out of Jail Free" pass or a Wonka Golden Ticket. It was five days of not sitting in a classroom. The kids were our responsibility for three meals and overnight, but otherwise they were herded like sheep from activity to activity and supervised by the camp staff for purposes of learning and soaking up the nature. Compared to school, it was a free for all. There was plenty I could have done instead of going; the first couple of weeks of school were always busy. Lots of consultations with parents and doctors, meetings with teachers, health plans for some of the more fragile kids. I had already spent two weeks prior to the first day of school preparing for the trip as well as for the kids in my school with health needs.

These 6th graders had just moved on to the middle school, but I knew them well; they had been my responsibility for grades 3-5, with their health problems, adjustment issues and daily boo-boos. Although there was a camp nurse who distributed meds, my presence was pretty much redundant. It was my guarantee of being there that sealed the deal for parents that their kids would be safe and well cared for. Oh, I  checked peak flows and did asthma checks so as not to be awakened for nebs in the middle of the night for wheezy kids. I located the kids who forgot to show up for meds. I could tell by a look who needed special attention or a pep talk. I managed the diabetics exclusively.  On occasion I made a trip to the ER for a few stitches (those kids always got treated to a burger or ice cream on the way back to camp but were sworn to secrecy). I always had a few kids who had never left home for as much as a sleepover, kids who were on the verge of illness, or kids who were allergic to everything including clouds. Every year there was one or two new kids who had moved to town and didn't have a single friend and arrived with some sort of medical issue. I gave the really nervous parents my cell phone number since we usually left for the trip only 3 days into the school year and the mostly middle school faculty were new to the kids. Up until that year, no one had ever called me although I did make a few calls home so they wouldn't worry too much. Since the kids were forbidden to use the phone, it was always appreciated.

My own kids were nearly grown; my daughter was 21 and had already started her 3rd year of college the week before. My son, K, was starting his first year at a Boston area college the day after I returned. It was going to be a busy week and weekend, but it was all under control.

On that day, September 11, 2001, the kids were settling into their second day of after-breakfast activities with their camp leaders. The other 9 teachers and I had a precious 2 hours and 15 minutes until we were needed to chaperon free play time and then lunch for the kids. We were enjoying the beautiful sunny day on the deck overlooking a sparkling blue lake. It was summer still, but with that unmistakable crispness that meant fall would not be far behind. I remember how we admired the color of the sky and the green of the surrounding mountains, dotted with just a touch of red and yellow of early-changing leaves and how pretty it was as the view was reflected in the lake. Some teachers were milling around, reading the paper on the deck and enjoying a peaceful cup of coffee or just sitting and chatting.  Two of my good friends were 5th grade teachers. We were making a plan to escape to Dunkin' Donuts for some adult time and maybe taking out a few sailboats later in the afternoon when the kids were with their learning groups. Joe, a grade 4 teacher drove up in his car.

"Hey", said Joe, "Something really bad happened in New York at the World Trade Center. A plane crash.    I'm going down to the rec room TV to check on it".

We quickly followed, collecting most of the other faculty en route. I remembered that there had been a bomb attack maybe ten years earlier. I thought about the logistics of evacuating those buildings and what a nightmare it must have been. In my wildest dreams I could not have imagined the horror that was to come.

We sat riveted and in shock as the events of the day unfolded. It was like a bad dream; many of the teachers had tears streaming down their faces.  One teacher was married to a National Guardsman, another to a federal agent; both wondered not if but when and where their husbands would be called to duty.

At some point, it occurred to us: "What do we tell the kids?".

I suggested that we tell them nothing. There were 10 of us, how could we handle the emotional needs of 180 kids who might have a grandfather who works in one of the towers, or whose aunt lives in New York, or
whose cousin works for an airline or the fire department?

Joe agreed.  He suggested that we talk to the school principal; after all, it should ultimately be their decision. We could be called home right away. Parents would be calling the school and the camp. We had to be prepared for an onslaught of parents driving the two hours to scoop up their kids and bring them home and who could blame them?

Cathy was a 5th grade teacher who worried about the safety of us all. With planes targeting the Pentagon and White House as well as the Twin Towers, who knew what could be next? Was it safe to even be on the roads?

Two 6th grade teachers, Sally and Carl were the undisputed team leaders. They thought the best plan was to keep things as normal as possible until we heard otherwise.   As a group we agreed, then scattered to meet up with our kids before lunch for 45 minutes of free time.

Joe went to find the camp director; Sally tried to contact the school principal and/or the superintendent's office. Overloaded telephone systems and a serious lack of cell phone service prevented her from reaching anyone. For the next several hours, in fact for the next three days, we were cut off from the world and on our own.

During the lunch break the camp staff taken off and briefed by their director, who ordered them to keep things as normal as possible for our kids. Some were unhappy about that, but we were insistent. They would stick to the program.

It was late afternoon before Sally was able to speak to anyone from school administration. They agreed with our course of action; they had had a meeting with parent organizers and the consensus was that as long as we, the faculty, were OK with staying, the kids would remain at camp; the only difference was that we would leave after breakfast on Friday and arrive home before 1 PM instead of 5 PM. Teachers on all three buses would brief the kids on the way home.

And so, as our country grieved for the lives lost, the threat to our freedom, and the near-destruction of our piece of mind, our kids learned and played. They bonded with teachers and classmates as a group, communed with nature, and made memories. They missed home a little, and school not so much. They had the freedom to eat peanut butter and jelly instead of veggie burgers, and some enjoyed their sloth, showering and wearing clean clothes only when compelled to do so. For three more days our students did all the normal things they had a right to do as kids. They did not have any access to TV's or newspapers; our only link with the outside world was a few moments of news casts several times per day and newspapers, which we kept hidden. The kids were isolated, not having access to either. We, their teachers, protected their innocence for just a few more days, shielded them from fear and from the rest of the world.

That Friday as I drove home, it seemed as though I had landed in another world; I had never seen so many flags flying from homes, schools, fire stations, police stations, public buildings. Hand made signs and banners proclaimed that we as Americans were still strong, that nothing would break us. There were pleas for vengeance and retribution. There were prayers for peace and for the families of the victims.

For Baby Boomers like me, the assassination of President Kennedy was a tragedy that changed a generation.  For this generation, it is September 11, 2001.

But for our kids, our 180 students, our group of 11 year olds who had left home on a Monday and returned to a changed world on Friday, their experience was significantly different. In their before and after world of 9/11, there was a big pause filled with childish things, a right of passage unmarred by those attacks in our own backyard. The world stood still for most of us, but for these sixth graders life was as it should be.

I think of those kids, and how their experience at Nature Camp may have shaped their future; perhaps not at all. But I cherish a note written by one of the parents to the 10 of us who were with their children during one of the darkest moments in history to thank us for what we had done.

"Our kids did not watch TV; they did not see the horrible images or the constant replay of planes striking the Twin Towers. Thanks to you, our kids got to experience normalcy and innocence in a way that none of the other kids at school did, perhaps not anywhere in the country.   We are so fortunate to have such dedicated individuals who put the needs of our children first when there was so much uncertainty in the world. Surely you feared for your own families, but never showed it to our kids. Thanks to you, we had 180 of the happiest kids in America".

In Terrorum

2011-09-08T23:49:00.021-04:00

Ms. Annoying, one of our very frequent fliers, came in the other day having been MIA for about 4-5 months. Her many, many visits were always an energetic pursuit for narcotics for one of the Holy Trinity of Chronic Pain Complaints^TM (back pain, dental pain, migraine) but that was not why she had come in. She was having some kind of allergic reaction and suspected a new antidepressant. She has always been known for disruptive behavior and abusive language when she doesn't get what she wants. This time she seemed pretty normal. It seemed odd to me that she had no complaints of any type of pain, but people don't always disclose the "actual reason" for their visit in triage.

After an evaluation by the Mac, I went over her discharge instructions with her that included only a prescription for Prednisone. Apropos of nothing she said: "I am totally off narcotics. I was in rehab for three months".

Wow.

I was floored. "I'm happy for you. That is such an accomplishment, it must have been very difficult"

She told me her story of three very intense months. She had lost her children but found the strength to persevere. She had been in the process of rebuilding her life one step at a time. Good for her, I hope she can keep it up and I mean that sincerely.

"I know I must have been a nightmare when I came in here before. It is a terrible thing, addiction. It consumes you, and that stuff is poison. Nobody should put those drugs into their mouth unless they have cancer. Tell all the doctor's; narcotics are the devil".

Well, of course they are when they are abused. I am thinking that this might be an effective strategy in a religious hospital. "I'm sorry, ma'am, I regret that we cannot give you any percocet as they are Satan's handiwork. Here is some ibuprofen".

Right.

Not That it Matters, but....

2011-08-25T21:09:00.003-04:00

I was on the other side of the health care delivery system recently, having a relatively minor surgical procedure. Which took me just a little longer to bounce back from, but no matter. I am on the mend and back to most of my exciting physical activities. Except I am not allowed to lift my kayak for another week or so.

I was more than happy with the care that I received from start to finish, from checking in to the pre-op area to the next day follow up phone call. I have to say that I did not use my own health care facility for this procedure, even though the surgeon is there more days per week than at the "other" place. Why?

They piss me off. For one thing, the PACU nurse manager is a moron who apparently doesn't think ER experience is enough of a critical care criterion for working in a same-day surgery unit. For another, I just couldn't see myself as a patient where administrative types are so totally clueless they don't value or even have the ability to recognize that people are working really hard. I am sick to death of the constant reminders and whip cracking. That not giving 100% every second of every day is going to doom us all, given that we are experiencing layoffs and all. The buzz word is "Strive for 5", (as in 0-5) a reference to Press-Ganey five-point scale that patients use to grade our attentiveness and care. They just don't get that people, especially nurses, are doing way more than the best they can. Guess what, you are not the number one hospital and never will be because you have a lot of deadwood making stupid decisions and fail to listen to the people who make good scores happen.

Because we feel like we are always being beaten up, there are days when you just don't feel like Strivin' for 5.
It might feel like "No More Than 4"
or "Three is Fine for Me"
or "Two Will Do"
or (rarely) "One and I'm done"

It was interesting to be on the other side of the fence. I knew that care would be good if not great because I used to work there. I liked it well enough, certainly the ER was better organized and managed. I took my current position because it worked out with school and all. But, I'm no longer in school (at least, not for the moment) and it might be time for a change.

I Know Who I'm Gonna Call

2011-08-24T20:59:00.031-04:00

Another night with Parvati, the usual running around. Except we had Actual Emergencies^TM. A STEMI transferred out; an 8 year old with severe reaction to bee sting; a 10 year old with SVT. More bee stings. A 15 year old whose ulna and radius looked as if he had sprouted another elbow. Shoulder dislocation. Yeah, busy for us with our limited resources.

Plus we had our usual contingent of dental pains and neighborhood "I had nothing better to do so I thought I'd go to the ER for this minor problem I have had for 3 months".

To add to the perfection of the evening, I also had to work with SIC. SIC and Parvati don't like each other much.

I don't like either of them much. So it was kind of fun to watch them sniping at each other. For once I was Nurse Good. Hahahahaha!

At the height of the insanity, and quite without dinner, we didn't have a single room free except the Code room, having either shipped off or discharged all Actual Emergencies^TM except for the little girl with SVT and the kid with the bee sting. We still had a boat load of others occupying rooms.

Not Cheri told us we had another triage. "She's a little dramatic, says she cut her finger off".

Me: "Do you mean actual finger-in-a-baggie cut off, or high drama boo-boo?"

Not Cheri: "No finger in a baggie".

Second in Command went to triage her, a 24 year old well know to us for frequent visits for complaints and maladies better treated with common sense than emergency care. She was sent along with her demanding and unpleasant parent to the registration area since we didn't have a space to put her.

Minutes later, I saw a blur as Parvati raced her back to the Code room via wheelchair and unwrapped the finger. Call the helicopter. Help, murder, police. It was an avulsion from a vegetable peeler. They may be painful, but not race-back-to-our-only-available-bed urgent. I glanced briefly into the room and quickly lost interest.

Parvati came back to the desk, actually shamefaced: "I'm sorry, I'm sorry, her mother said she was going to pass out, I just thought she should probably lie down. I didn't realize it was such a tiny cut".
SIC: "I know her. She is very dramatic and stupid,and her mother is an idiot"

I witnessed this exchanged with my mouth open. For one thing, Parvati never says "please" or "thank you", never mind "I'm sorry". This was.....unprecedented. For another, what was this? Perfect SIC calling a a patient stupid and the mother an idiot?? And Parvati pushing a wheelchair? And I am well behaved??

What, am I in Bizarro World? UP is DOWN, BLACK is WHITE, NIGHT is DAY? What's next, human sacrifice, dogs and cats living together... mass hysteria? This could be either very good or very bad; I will go to the experts for an opinion. since I'm fuzzy on the whole good/bad thing. What do you mean, "bad"?

Dr. Egon Spengler: Try to imagine all life as you know it stopping instantaneously and every molecule in your body exploding at the speed of light.

Dr. Ray Stantz: Total protonic reversal.

Dr. Peter Venkman: Right. That's bad. Okay. All right. Important safety tip. Thanks, Egon.

On Not Feeding the Monkeys

2011-08-13T12:37:00.008-04:00

I discovered that irrepressible Kate, my newest partner in crime had created the latest time wasting activity (in addition to coming up with songs for my "ER Complaint Soundtrack", more on that another day). It was a list of bogus initials to use when we input EKG's. It should be entertaining when the EKG wench calls to berate us for somehow managing to screw up and make all kinds of work for her. The list includes:
LOL
BFF
BRB
OMG
PIA
PID
WTF
IMO
IDK
Doing EKG's is kind of time consuming because there is lots and lots of important patient information that has to be typed in. In an actual emergency, it is possible just to put "911 chest pain" in and edit the particulars later. Because there are two different sets of 9 and 11 digit identifiers, on occasion there might be an error. Or a misplaced letter when we type it in (no scanners here). We make every effort to be accurate with these, but what can I say: we are human. Instead of merely making the changes in the EKG department where each study is wirelessly received (the wonders of modern technology!) the evil EKG troll has a hissy fit, way down in the EKG cave where she resides. I don't thing she sees daylight, or humans, that often. She will frequently file an error report and/or call us. She lacks adult social skills big time, and has a tendency to screech. I handle this type of rude telephone behavior with my usual professional skill. I simply hang up.

"This is EDNurseasauras, how can I help you?"
"YOU GUYS HAVE SENT 4 EKG'S THIS WEEK WITH MISSING OR INCOMPLETE INFORMATION!"
"Call me back when you are calm and can speak to me like a professional". Click.

Kate: "Did you hang up on EKG again?"
Me: "Yep. She still hasn't learned, but I remain hopeful"
Ellen, 30 seconds later: " EKG is on the phone. She wants to talk to whoever hung up on her. She didn't sound happy"
Me: "Ellen, was she rude to you? Seriously??" (I get really pissed when people are rude to Ellen)
Ellen: "Oh, well, heh heh. She was a little....high strung I guess"
Me: "This is EDNurseasauras. I will not tolerate your rudeness to me OR my staff. If you can lower your voice and communicate respectfully I'm happy to hear your complaint. "

YOU...YOU...YOU'RE ALWAYS HANGING UP ON ME! DO YOU HAVE ANY IDEA HOW MUCH OF MY TIME THIS WASTES WHILE I...."

Me: "Look, I'd love to chat with you about the logistics of your job, but mine involves actual patient care. In fact, I'm going to do CPR right now since my partner is signalling me to get off the phone. Have a nice day".
CLICK!

Kate (grinning and shaking her head): "Lady, you do love to poke that bear in the cage, don't you?"
Me: "That's no bear, it's hardly a trained monkey. But she does have opposable thumbs....I think".

The next call was from the nursing supervisor.

Supervisor: "EKG troll called me to complain that you keep hanging up on her"
Me: "Yes, that's true, but only twice today. Let me ask you: she was shouting, wasn't she? How long did it take you to calm her down so that you could get the story out of her?"
Supervisor:" Um..."
Me: "That's what I thought. I was perfectly polite to her, but she continued to use a raised voice and unprofessional communication technique. So I terminated the conversation. I will be happy to talk to her if she acts like a big girl. Please have her read her telephone manners guide. She needs to calm down before she pops an artery or something"
Supervisor: "Hahahahaha!"

I understand that her job doesn't involve much actual communication with people, but you would think that someone who has been working in this place for 10 years would be better trained. Perhaps the Clip Boards simply throw her a piece of raw meat every once in awhile, who knows.

So, getting back to the initials. Today I just used "SOB". I think EKG troll would agree with that.

No Soup for You

2011-08-12T17:07:00.019-04:00

An 18 year old male came in with a finger laceration, doing the drama dance. "It burns! It burns! The pain! I think I cut it to the bone!". I glanced at this monstrous wound to find a tiny little laceration on the pad of his finger after unwrapping it from within its nest of 1/2 of a cut off tube sock, and some blue string. It was a nothing injury, not even bleeding.

Next, he handed me some pharmacy labels. "I had a car accident and my back is really messed up. My doctor is on vacation, so can I get a prescription for these too?".

I don't know who would ever put an 18 year old on oxycodone, but my triage note read:

"1. Laceration. 2. Requests narcotic refill".

Most of the docs know that when I number the triage complaints there is probably a much longer story behind it. The most I have ever had was 6 sequentially insignificant complaints.

Parvati didn't even put glue on his booboo. But she did ask me to call the provider who was supposedly on vacation. Guess what? He wasn't. The office manager was kind enough to share with me that the patient had called their office only this morning with a similar request for meds, but gee, he had just been given a 'script only 5 days ago. He was told he would have to make an appointment since that was way too soon to be thinking about a refill. Did I still want to speak to the doctor?

Nope. You can just go ahead and make a notation in his medical record before he automatically gets the report of his patient's ER visit. Just another little service that we provide.

I put a bandaid on and prepared to kick him to the curb. But I did tell him that I had contacted his doctor, who now knows he is on the scam for more oxy. "I'm only sorry I can't call your mother since you are over 18", I said.

"Oh, that's not good", he said, hanging his head. He simply turned around and left, and I doubt he will be back...this week.

Thank you, Medicaid, for providing this young man with free doctor's visits, no-cost ER visits, and the means for an 18 year old to earn some cash this summer.

Yikes.

"Heeeeere's Johnny!

2011-08-11T22:51:00.010-04:00

I am ready for some R&R after the last 5 day stretch, seeing 23, 24 patients per shift. This wouldn't have been so bad if it hadn't been an endless parade of IV's, EKG's transfers, and nothing simple. What made my last few shifts unbearable was the presence of Parvati. The ex-surgeon in her likes to do her own dressings, but she is pretty helpless when it comes to actually finding anything:
"Where is the gauze?"
"Where is the bacitracin?"
"Where is lidocaine?"
"Where is the tape?"
"Where is the extra saline?"
Anxiety=cardiac workup, EKG, labs, etc.
Chronic migraines=IV fluids, narcotics, sometimes Toradol and then narcotics, anti-emetics and tying up a room for 3 hours. And a prescription for Percocet.
The "I need a refill of my Percocet" crowd usually goes away empty handed for some reason.

I usually ignore Parvati's rapid-fire verbal orders which annoys her; then she asks the other nurse, who also ignores her. This is not simply to be a pain, but she will frequently change her mind, which just makes work for me, inconveniences the patient with additional veinipunctures and makes me cranky. Ignoring her really amounts to saying, "Just go ahead and write the orders, I am doing the other 4,000 tasks you asked me to do; remember, there is only the two of us to do everything. It takes you two minutes to do the exam, but it takes us a lot longer to do these things. You need to be patient. Why don't you go eat dinner (and get out of my way?)".

Hilariously, Parvati hasn't complained about me yet. She did complain to our boss about Second in Command, who in her desperate attempt to appear competent and all-knowing comes across as be a little overbearing with new doctors. She will argue or give them her 2 cents about what they need, second guesses them and makes herself seem indispensable. I never argue unless I have a damn good reason so I
don't come off as a squeaky wheel. It's not time to argue until it's time to argue, a corollary to It's not time to panic until it's time to panic. That way, if tell a doc I am worried about this or that they actually listen to me. Parvati, though...doubt she listens to anyone since she makes way too much noise to hear anything anyway.

After three of the longest shifts of my life with Parvatti for ALL THREE SHIFTS I was feeling a tad....homicidal. Which accounted for my mutterings

REDRUM
REDRUM
REDRUM.

I suddenly have the urge to re-read "The Shining". And maybe buy an axe.

When it Just Isn't Fair, Part One

2011-07-31T19:21:00.030-04:00

The world is full of people who don't take their meds for high blood pressure, don't follow a diabetic care plan, or are so obese they cannot walk. People have all sorts of reasons for not following a doctor's advice. Hey, it's a free country; people can do whatever the hell they want. As long as they are well informed about the possible consequences and are able to make their own decisions, let the chips fall where they may.

You never hear a patient say things like, "I didn't KNOW I wasn't supposed to smoke when I am on oxygen!". Clearly it is a decision that the patient makes on his/her own and damn the consequences. Even if the consequences include further complications, severe burns and/or blowing your home sky high in this case. No less deadly than deciding not to take care of diabetes and high blood pressure I suppose.

There is difference between outright irresponsibility, choosing not to take care of yourself and being unable to afford your treatment. So many people don't have insurance, so where does that leave them?

In one of two places.

Group one has no insurance and uses the ER for everything from a rash to a mosquito bite. Some are such frequent fliers we know what kind of car they drive, know their address when the ambulance tones out for their 143rd ER transport for abdominal pain this year, and can accurately predict their visits based on the day and date. I don't know how they survive because they are not, for the most part, working. They come late at night when they know they will be given a supply of meds to "tide them over" because the pharmacy is closed. They want every test possible and they want it now. They have no intention of paying their bills. They are usually heavy smokers.

Group two may have a job and no insurance. Or may not have a job at all. They are trying to make ends meet, cannot legitimately afford their care or their meds. They are undemanding and try hard to keep their costs as low as possible. They are the ones who will struggle for years to pay their medical bills. The hospital will hound them for $25 and send it to a collection agency.

It is especially tough on people who work for themselves. And hurt themselves while working. The double whammy is that not only are they not able to afford an ER visit, now they are out of work.

The system works so very well for some people and not at all for others. Why can't we fix this?

More Stupidly Spelled Names

2011-07-30T13:25:00.025-04:00

This is a bunch of idiotically spelled names. This is a week's worth. I have included the traditional spelling as well for reference.

Mickaylia (Michaela).

Falysha (Felicia)

Kameryn (Cameron)

Josslin (Jocelyn)

Linsay (Lindsay)

Skyla, and Skyler both in the same day (Schuyler)

Jaymz (James). Yikes.

Xander (?)

Alysha (Alicia)

Jarrid (Jarrod)

Allden (Alden)

Justen (Justin)

Kaleb (Caleb). This kids last name also began with "K". You know how I loathe alliteration.

Apriel (April). Not sure about this one, although the kid will be spelling her name forever.

Sybrynna (Sabrina, and pronounced as such)

Haileigh (Hayley) Not as bad as Sybrynna

Aeden (Aidan). This one is not necessarily wrong as there are about a dozen ways to spell this, but again, this kid will be spelling it for everyone.

It is crazy how many people never bother to look up the correct spelling of a name they like, or spell it any whay they want so their kid's name will be unique. Some are so obviously spelled phonetically. Then, there is the unique vs. over the top stupid.
Psandeigh = Sandy
Ps2ughe= Sue
Ahndreighah = Andrea
Chandis= Candace

I left my list of names at the desk so others could add to it. Brian had this to add.

"When I was in Texas I had two patients with unusual names. One woman pronounced her name "Sha-THEED". It was spelled "Shithead". Then there was the kid named PAJ-a-mus, that was how it was pronounced although it was spelled "Pajamas". I asked the parents what the inspiration was for the name and they told me they saw it in a J.C. Penney catalogue. One of the kids was named Pajamas. Guess what he was modeling?"

Creepy Steve

2011-07-29T23:30:00.001-04:00

Kerry worked a very unusual evening shift with me, a painful shift since the patients trickled slowly in. One. By. One. Drip, drip, drip. Like a leaky faucet. Like I said, painful. Plus Gil was on, which means the word was out on the street to all the drug seekers. Dental pain, dental pain, dental pain. Chronic back pain. One guy apparently just didn't feel like going to work and wanted a work note. And percocet for his trouble.
Gil will give one to go, or a prescription for, like, four tabs. Which Gil will elaborately write a script for so that it cannot possibly be altered in any way.

Feeding squirrels, I call it. If you feed them, they will always come back.

With Mary retired, there have been a succession of xray techs. Some better than others. We like (and have decided to keep on our weekend) Shane. Cute, blonde haired and blue eyed and really young. But sweet, and we will enjoy bringing her over to the Dark Side. Unfortunately, she won't start on the weekends with New Cathy and I until September. Until then, we have Creepy Steve.

He is really, really creepy. He talks slowly and deliberately and enunciates. Every. Single. Word. He is painful to listen to plus he is a sidler- he sidles. He just appears. Not there, there. Not there, there. I hate when people sneak up on me. Like he's trying to catch me doing something I shouldn't be doing, or looking over my shoulder when I am looking at my email. Creeeeeeeeeeeeeeeeeeeeeeeeepy.

And then, there is his interpretation his completed studies. Especially the extremity films. It is apparent he can't read xrays for shit, especially shoulders and elbows. Most xray techs are really good at this, him not so much. He is wrong at least 75% of the time.

13 year old with a nothing 2 day old forearm injury; no swelling or bruising and a stupid parent who is in the department with one of her 4 idiot kids at least 3 times a month. Gil sends him over for an xray even though it is clearly a waste of time and the taxpayers money. Must keep up those customer satisfaction ratings.

Creepy Steve: (after sidling over next to me while I'm writing) "I'm. Pretty. Sure. This. Is. Broken. At. The. Distal. Radius"
Me: "Really? Distal radius? 'Cause his pain was proximal especially when he wasn't playing with his phone"
Creepy Steve: "Hmm. It. Is? It. Looks. Like. A. Buckle. Fracture. To. Me."
Me: "Ok, well Dr. Gil is reading it now. We'll see. If you think it is a fracture why don't you go ahead and make a disc so they won't have to wait for it". We routinely have a disc made of the positive xrays for patients to take with them so they can convenientlybring to their orthopedic doctors. Digital xray technology makes this possible.
Creepy Steve: "Yes. I. Will. Do. That. Right. Now."

Predictably, there was no fracture. But the idiot family got a nice souvenir.

Next patient is someone well known to us who "dislocates" his shoulder about once a month with ridiculous stories about how it happened. The mechanism of injury never makes any sense. He hoots and hollers, moans and groans and disrupts the whole place. He usually "forgets" to stay in character and uses his arm to change position or remove his shirt. He always comes in on a Friday or Saturday. We always do an xray. It is always negative, but his bad acting will sometimes get him narcotics. I repeat, his xray is always negative. "I must have put it back in place". Riiiiiight.

Creepy Steve: "This. Looks. Like. A. Posterior. Dislocation. To. Me. And. Maybe. A. Small. Clavicle. Fracture"
Me: "Oh? Gee, he complains about pain everywhere. I touched his t shirt that was lying on the bed and kicked his backpack by accident and he screamed. I suppose it is possible". Unlikely, in fact I would bet a week's pay on nothing fractured, dislocated or even injured. It wasn't. Gil gave him one Percocet and kicked him to the curb.

Creepy Steve occasionally gets it right; he is, oddly, better with chest xrays. In spite of his creepiness, I try to be nice to him and talk to him since I don't think he has been out of school for long. I have a strict rule not to eat the young 'uns. The Mother Ship likes to hire people with very little experience since they don't have to pay much. We have a lot of long-term xray techs who feel as if they will be given the boot at any minute since they scrutinize every move they make and these young techs are cheap and plentiful. I guess his technique is good, which is a plus since there is nobody on-site to help him if he runs into trouble or has a question.

He did ask us if we wanted anything from the pizza joint as he was ordering out for dinner. No, but thanks for asking. For some reason he ordered two although he was the only one eating them.

Creepy Steve: " I. Like. To. Have. Pizza. At. All. Meals. So. I. Get. Enough. To. Last. The. Week."
Oh. Pizza at EVERY meal? Really??

I don't think Shane will want pizza at every meal. Can't wait for her to start on our weekend.

Evil, evil

2011-07-25T00:07:00.018-04:00

I worked more overtime in the last week than I care to, so getting out of work only 10 minutes late was a treat. One of my all-time favorites was just kicking up on the radio, Back in Black (Hell's Bells, don't you think 50 somethings are into ACDC?) so I cranked it up good and loud as I cruised through the town square on my way home. This was followed by a a little tasty Collective Soul, December. Great ending to a pretty good night, even if 1) it wasn't my weekend to work and 2) I had to work with Second in Command (SIC).

She is treading veeeeerrrrry lightly around me these days. Everything from avoiding writing notes (which I can't stand) to apologizing profusely for calling me at home. Never before 10 AM though, because I would just go ballistic. At least that's what she thinks.

Jane, my boss has been out of work for weeks with an injury that keeps her home and out of the office. We have all pretty much decided that SIC is not the de facto boss that she fancies herself to be. With Sherry in Alaska for a month I am the only one she can't intimidate, and everyone knows that I intimidate her.

Sherry wanted to have a meeting before she left to elect me Second in Command....bwahahahahahahaha!
Ha! Hahahahahahaha!
Haha!
I am the only one with any actual leadership/management experience, really. But I wouldn't drive that bus even if it was chocolate and had a marshmallow center. I am more of a back seat driver. Next-level-up management at this place does seem to have marshmallow fluff for brains and I am not sitting in any meetings with them. Besides, they pay us through a pea shooter and try to screw the nurses out of every dime imaginable. I'm sure they are wringing their hands while they decide to cut out coffee and hot water. They sure as hell ain't paying any more to someone who volunteers who go take on this kind of foolishness.

I can use my evil genius for more interesting things like manipulating the schedule so SIC gets less overtime, streamlining the code cart, and intimidating SIC. While wearing this T shirt, perhaps, order it from here:

My boss called and asked me if I would consider becoming the designated on-site super-user for our new electronic medical record training. Sure. For overtime. SIC will be really pissed about that. Yep, I'm gonna order that t-shirt.

More from the Lady on Elm St.

2011-07-24T08:46:00.001-04:00

Maybe it is the heat, but Lady has had 3 visits to us and 2 visits to the Mother Ship in the last 6 days. We KNOW when the ambulance goes out after her; the address is well known to us all. Even Ellen picks up on it. "Oh, no, they've gone out after x Elm St. again! Dr. Cripes already saw her once today!"

I quickly scanned the number of visits for the year. Between both ER's, outpatient labs and xrays, and a couple of outpatient procedures there were 67 hospital visits. By far the majority were for emergency care.

I know she likes Cripes, but he has had it with her.

"No way! She's goes straight to the Mother Ship when they call it in. One visit per doctor per day; any more is beyond the call of duty".

Interestingly, when she saw that Brian was on duty down at yonder Mother Ship she said, "What, him? I'm not seeing him". She really doesn't like Brian.

Two hours later she called. I can't prove it was her, but won't swear that is was not: "Hi, can you tell me who the doctor is today?"
Me: "Who's calling please?"
Caller: "Um....Mary"
Me: "Mary who?" I asked pleasantly. And politely, don't forget that I was polite.
Caller: "Mary......Smith. Why do you need to know that information?" Mary Smith is known to be Lady's cousin or some such.
Me: "Well, Mary, I'm sorry, but we just don't give out that information"
Caller: "That's ridiculous! How dare you refuse to tell me who the doctor is"
Me: (Very sweetly) "Yes, I know it is inconvenient, but it is a safety issue"
Caller: "Safety! What has that got to do with anything! Do you think someone might come down there and kick his ass?"
Me: "That is always a possibility, Mary"
Caller: "I've never heard of anything so ridiculous in my life! How am I supposed to know if I like the doctor who's on?
Me: "Well, Mary, that is problematic. However, in an emergency situation such as life threatening illness or injury, most people are OK with that. If you do not have an emergent problem, the alternative is to see your primary care provider"
Caller: "Well, it's an emergency if I say it is an emergency"
Me: "Yes ma'am, I would never presume to tell you not to come to the ER if yout feel your problem is so serious you cannot wait to see your doctor"
Caller: "Well, I don't like your tone, and I am going to complain to Patient Care Services tomorrow. I'm going to tell them that you were rude to me"
Me: "Yes ma'am, that is your prerogative. Why don't you give me your phone number so my boss can discuss my rude attitude with you personally. Mary Smith, correct?"
*click*

Bye, Lady. Have a nice night.

Our Witch Melted, Can We Have a New One? and other random stuff

2011-07-23T06:18:00.050-04:00

That is actually a paraphrasing of a blog, LOVE the name. You could check it out. But it IS an appropriate sentiment for the 100+ degree heat here in the Northeast and the potential for problems. You know, like dehydration, heat stroke and other such heat related issues, many of which can be prevented from becoming a MEDICAL EMERGENCY by following a few common sense tactics: stay hydrated, keep cool and STAY THE HELL OUT OF THE HEAT, MORON!

I worked a princess day shift, my 10th shift in 9 days and I am done with it. I am sitting in my living room with an icy cold brew with both the air conditioner and fan on. In a sundress (which I would never wear outside in public unless I was, literally, on fire). Tina went out for 10 seconds and was ready to come in immediately, so not like her. Mr. EDNurseasauras and I will not be heading to the lake for the weekend as planned. We will take a day trip, but there is no airconditioning there and we just suffer too much without it. Wah, wah, wah.

"With record high temperatures, the heat is on!" (isn't that clever, I thought. Not!). "Medical personnel are on high alert!", intoned the 6 PM news reporter.

"I'm not", I informed Mr. EDN. "I'm on exceedingly LOW alert".

The local TV channel had a reporter at Fenway Park giving tips about how to stay cool while at the game. It is over 100 degrees Fahrenheit, the highest temperature in about 80 years.....they were using some sort of heat seeking, satellite directed, laser guided thermometer to take the temperature of the plastic seats in the bleachers. 118 degrees. WTF? The concrete steps? 148 degrees!! You could literally fry chicken on that thing, and you want people to sit out there? Madness!

Here's a tip for staying cool while watching the Red Sox: STAY HOME. Or go to a bar with this new-fangled thing called air conditioning. Yikes.

I was on the phone (on hold) when a well-dressed woman walked into the department carrying one of those Styrofoam beer coolers containing bottled water. It was our Director of Nursing. "I know there is no water fountain, and want you all to stay hydrated". Nice. How many of y'all's bosses toted in water? I was impressed.

I was even more impressed that since we had run out of enema bags she went across to the pharmacy and picked up a couple.

Just....no words for that. I sense a great new marketing campaign:

"Record high temperatures may cause dehydration and heat injury. But by far the most dangerous problem is....constipation. When you need an emergency enema, go directly to the Emergency Room. Your God-given right to a comfortable bowel movement should be your number one (not number two) reason to come to the ER when it is about as hot outside as the surface of Mercury. Because the heat is so much easier to tolerate when you can just take a good crap".

Eh?

2011-07-22T18:11:00.000-04:00

Me: (after blowing a shit load of water into the ear of a young man with waxy buildup, 2nd stupidest reason on earth to go to the ER after "constipation"):
"CAN YOU HEAR ME NOW?"

Oh, the pain

2011-07-21T13:27:00.006-04:00

Madness has a dual perspective on living with a family member with chronic headaches, and having to deal with those who show up regularly in the ER with same in order to get narcotics. I pretty sure every ER has them. We are told that people's pain is people's pain, and who are we to say they do or do not experience what they say they are? Give them what they want and they will go away and give us great customer service reviews.We are just supposed to treat it and move on.

We do. But it gets more and more difficult when it is clear that the habit is like feeding squirrels. Give them a prescription and kick them to the curb. The docs aren't here all the time and so it may be weeks or months before they see the patient again. We nurses are having to deal with the drama and bullshit, the manipulative behavior, and the enablers with bad manners. And feel like pushers to boot.

Stopping at ER has become just another part of the routine for some; drop off the dry cleaning, get a pedicure, make a deposit at the bank, pick up dog food, lunch with a friend, then stop at the ER for a quick dose of dilaudid. Oh wait, let me get that extra large iced coffee first, and my cell phone needs to be plugged in, what outlet can I use.

Our newest doc gives out few narcotics. Mac is all about being reasonable, and things like whacking your shin on the bathtub 10 minutes ago with no bruise and no swelling doesn't necessarily get you Percocet. Especially if there are multiple visits for pain-related complaints. He doesn't feed the drama, and like Gil, likes a nice, Zen sort of ER. LOVE him. He is a great addition to the ER family.

Now if I can just get Parvati to drink that particular Kool-Aid my life would be so much simpler, sigh.

Um...

2011-07-19T13:51:00.000-04:00

I watched on the monitor while a young man in his early 20's walked across the parking lot. By the time he reached the door he was hunched over and moaning. Back pain.

10 minutes later, I watched another young man, also in his early 20's do the exact same thing. Back pain.

Neither had insurance.
Neither had ID.
Neither could remember their temporary local "new" address or phone number. They both gave a different a different permanent address, same town in another state.
No, they didn't know each other.

They said they were both roofers. One of them listed "seizure disorder" as a medical problem. The Talker sent them out with whateva pain meds and a work note.

"REALLY?? I said. REALLY??! Fraud and bullshit aside, a roofer with a SEIZURE DISORDER?? Seriously??!"

"Oh. I didn' t pick up on that".

WTF?

Curb Service

2011-07-18T22:25:00.018-04:00

I am always leery when people come to the door asking for a wheelchair. Hauling people out of cars is not my favorite activity for several reasons;   I am not a young woman, my back is fragile from years of abuse, and mostly women work at my facility. Except for Brian and possibly the Talker, there aren't any really manly men available to do the heavy lifting. Bobo is just useless, Gil has a heart condition and Cripes has a bad back; the rest are women. Most importantly, I simply do not  possess the superhuman strength required to prevent someone extraordinarily weak ( or large) from hitting the pavement. My back is not going to pay the ultimate sacrifice; I have many more years to work until I can retire. Even though it is very often more of a case of high drama than multiple trauma,  I will not risk a patient's well being or mine trying to get them out of a vehicle safely. If there is an overabundance of drama or a legitimate reason, I will go the EMS route. Emergency Medical Services peeps are the extrication experts, and I don't hesitate to call them for assistance when the situation warrants. However, for the most part, if you hauled your fat ass into the car, you can damn well haul it out. I will hold the wheelchair and guide you.

The wife came in looking for help to get her husband out of the car; it wasn't quite clear what he had done, but Kate and I trudged out to the car with our trusty wheelchair. "He's an amputee, has one leg", the wife informed us.

"AAAAhhhhhhhh, AAAAAARRRRRGHHHHHHHH, OOOOOOOOOOORRRRRRRROWWW, ah, FU*#! Jesus, aaaaahhhhhhhhhhhh, gggggaahhhhhhhhh! This hurts so fu*#ing much!"

I saw three little blond heads and three pairs of  enormous blue eyes staring at me from the back seat.

He fell down some stairs apparently.. His elbow hurt. So with one leg and one arm he effortlessly transferred himself from the car to the wheelchair, all the while spouting a steady stream of profanity and owwy noises. I decided to talk to the kids instead.

"Hi guys! What's up? This isn't your grandfather, is it?" He had looked to be about 40 years old, the wife a little younger; she snorted with suppressed laughter but didn't say anything..

The three little blond heads shook in disagreement. The oldest said, "He's my papa; he says he fell down. I didn't see him, though", while the littlest, a girl of about 4 stuck her thumb in her mouth. The wife had a subtle air of "been there, done that, now done with this" about her.   Interesting.

"It's OK, Kate and I are just going to take him inside and put a bandaid on him, alright?" Three little blond heads nodded silently. They didn't smile.

Once inside, Ralphie continued to make a whole bunch of owwy noises as we did our triage. He lost his leg in a motorcycle accident. Couldn't remember any of his meds; pain was 30 out of 10.

Through the magic of electronic medical records we discovered that Ralphie was on a shitload of meds. Pain meds. Can't remember my ass.

He got an Xray (negative) which appeared to have been therapeutic since he was using both of his arms to transfer himself without any difficulty from the wheelchair to the gurney. Still making with the owwy noises and profanity though. He got a shot of Toradol for his trouble. By that time he was hopping around on his one leg and opening the cabinet doors in the treatment rooms.

The wife wisely stayed in the car with the kids. If I was the wife, I would have just driven off with those cute, blond, silent little kids and never looked back.

Kids Eat, but it Ain't Free

2011-07-16T23:52:00.004-04:00

Tonight was my night to wrangle kids with lacerations.

I hate restraining kids. In fact, I really don't even like kids all that much. Actually, I take that back; the kids are fine, it's the parents who suck. That was why I stopped school nursing.

Kid 1: 2 years old and screeching blue murder. He had a wooden splinter in the bottom of his foot. It took Henrietta 20 minutes to get it out. It was near the big toe. Even wrapped in a sheet with both parents sitting on him and me holding down the foot, that big toe just couldn't be immobilized; it was like trying to nail Jello to a tree. At least his parents were intelligent, helpful beings with realistic expectations. They were tremendously helpful. I stuck a Cars bandaid on his foot and he seemed happy with that.

Kid 2: 10 years old with a teeny, tiny laceration on her thumb from the top of a dog food can. Crying, crying and crying, albeit silently. 2 stitches. Had to work around mom who threw herself onto the stretcher like it was an open casket. Made a WAY bigger deal out of it than necessary. The little girls older sister was more of an adult than the mother.

Kid 3: 18 months old with a chin laceration. It was 50/50 whether it needed sutures or not. Clearly, this child had never heard "no" a day in his life. Mom was busy getting out a picnic basket full of snacks and drinks in triage. I warned her not to feed him ( they cry so hard they usually vomit) but she would have none of it; "how else am I going to keep him occupied?". (Um, I don't know, read him a book, play a game of Parcheesi?). We were busy, it was about an hour before we could take care of him. I refused to put him in the room until Henrietta was ready to see him the minute he went in, By that time mom had moved through the picnic basket and was feeding him a Kit Kat. Mom was, predictably, less than helpful. I wrapped him in a sheet and as soon as Henrietta put in the local he screamed so much he vomited like Mt. Vesuvius. Surprise, surprise. This is why we tell you not to feed them.

But wait, there's more. The kid kept screaming, but in a kind of "It makes me feel better to make noise", self- soothing kind of way. Mom sang, really badly although you could tell she was thinking she could really sing, "The Wheels on the Bus". Only when she got to the "round and round" part, it sounded like a cat in blender.

"The wheels on the bus go MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round,
MMMMRRRRRRRREEEEEEEEEEEOUUUWW and round...."

and the kid would MMMMRRRRRRRREEEEEEEEEEEOUUUWW in his own way at the same time, so he sounded like
MmmmmmmmmmMMMMMMMMMMMMMMMMM MMMMRRRRRRRREEEEEEEEEEEOUUUWW
MMMMRRRRRRRREEEEEEEEEEEOUUUWW

MmmmmmmmmmMMMMMMMMMMMMMMMMM

Mom naturally wanted 4 pounds of antibiotic ointment and 100 bandaids upon discharge. Um, yeah.

Kid 4: Little girl, 5 years old. An older sibling had shut her index finger in a door, avulsing the nail. Both parents, two other kids, grandparents, aunts, uncles, and an endless parade of concerned general citizens came and went. By this time Gil had come in to work and he rapidly did a digital block since the kid was screaming like a banshee. Mom yelled at him because after he injected one side of the finger, he said "another pinch, dear". "DON'T TELL HER WHEN YOU ARE GOING TO STICK HER!!! IT DOESN'T HELP!". Oh, ok. She had about 300 questions, none of which had anything to do with her daughters aftercare instructions. She was very pissy, mostly I think because she had absolutely no control.

Kid 5: Dental pain, 7 years old. Really?? Seen by the dentist yesterday. Given antibiotic. Not Magically Better pills don't seem to be working because it's 10 PM and he can't sleep. Mom gave him Tylenol. Yesterday. Are you serious? A dose of Tylenol and OTFD*. Sorry, we do not give out prescriptions for Common Sense in a Bottle^TM

*Out the fu**ing door

Riveting TV

2011-07-13T22:07:00.030-04:00

Now that I am no longer a slave to schoolwork, you would think that I would have so much more time to add blog entries.

Not so. I am finding that when I am home of an evening, instead of being on my computer I am actually starting to watch some of the programming that has captivated Mr. Ednurseasauras during my academic incarceration. Not just sporting events, mind you, although I have written hundreds of papers while watching many a Red Sox, Bruins, or Patriot's game. More accurately, I was mostly pretending to watch, usually it is just white noise. Mr. EdN is an inveterate channel surfer and is addicted to the Discovery and History Channels as well as some of the political and economic pundit programming. He has a tendency to avoid the fluff; you know, premium channel train-wreck TV so ridiculous you just can't turn away. This is anything on MTV or VH1 (unless it is a movie like "Eddie and the Cruisers" or "The Buddy Holly Story"). He abhors anything having to do with Jersey Whores, Kardashian Krap, 257 Kids and Counting, or Kate Plus 8 and Jon Gets the Gate. I confess that in contrast, I never miss an episode of Toddlers and Tiaras. Ultimate train wreck CRAYZEE parents, which makes you feel good about raising normal well adjusted kids without spray tanning, fake eyelashes and big hair.

Instead of being shackled to my online classroom, I have been enlightened by such riveting shows as Swamp People, Swamp Logger's, and Ice Road Truckers. Then there's Pawn Stars, Billy the Exterminator, Dual Survivor, The Alaska Project, Everest Beyond the Limit.....etc., etc,. etc. Tonight we watched two hours of Navy Seal shows dedicated to the killing of Osama Bin Laden. That was pretty interesting, but what I really wanted to watch was True Blood. That's OK; the magic of On Demand allows me watch it in the morning while I have my coffee.

Most of these shows are pretty ridiculous, but one in particular I must single out as being the most pointless in pursuit of the loftiest goal. Whale Wars. Yep. Now, don't get your panties in a wad. I love animals and on paper it might seem like a grand idea to participate in the high seas equivalent of poking a hornet's nest with a stick in order to save whales from being harvested by the Japanese. I am not taking a stand on the legal issue of commercial whaling here; oh no. Whaling in pursuit of scientific research apparently IS legal; the Japanese emphasize that their activities are legal by holding up signs on their deck as they process their kill that announce "We're Weighing Stomach Contents"or "We're Taking Tissue Samples". In English. So the helicopter can see it. What boggles my mind is that the captain and crew of the Sea Shepherd are bumbling idiots. Referred to by some as "eco-terrorists", or "vigilantes", they roam the waters off the coast of Antarctica attempt to disrupt their "enemy" by taunting, cutting across their bow, throwing stink bombs, and tampering with their propeller . And sometimes getting rammed in order to indignantly cry "foul". Their actions just seem juvenile and impulsive while being more of a threat to human beings than actually seeming to accomplish whale salvation. I find myself rooting for the Japanese, frankly.

Without a doubt a more effective option than the Jackasses of the High Seas would be to put the Navy Seals in charge of disrupting whaling activities. Yeah.

One for the Bucket List

2011-06-22T19:21:00.039-04:00

So, last weekend I graduated. The culmination of countless (but probably millions) of hours in front a computer; countless (at least a hard-drives full of) papers, essays and projects; weight gain and lack of exercise; many thousands of dollars; working at a less than optimum job for far less than optimum pay to make time for study; spending less time with my family, especially when sequestered for weeks at a time for some courses; ignoring the laundry and most other household tasks.  While all my family supported me, only Mr. EDNurseasauras was able to make the trip with me, and he watched with pride as I walked across the stage to accept my diploma. It was only fitting since he was, above all, the one who bore witness to my daily struggles, frustrations, and personal achievements of the last four very long years.

From others, I heard an endless chorus of comments:  "are you STILL in school?", "what are you going to do with your degree?", "are you going to get any more money?", and "is it worth it?".

The short answers are: yes, ~~teach~~ I don't know, probably not, and yes.

I had second thoughts about attending graduation, it was a lot of money I thought I probably shouldn't be spending. Airfare. Hotel. Rental car. Meals. A recent out of town family wedding that, while a wonderful occasion, meant more travel in only a few weeks time. And, we just had our kitchen remodeled as well.

But, I did go, and it was worth every penny to have taken the opportunity to celebrate. I would not have experienced the joy, personal satisfaction and sense of achievement by simply opening a large white envelope
containing my diploma.

There were maybe 350 graduates in total, but only 75 nurses; it was about half and half MSN graduates and undergrads. My early flight on Friday morning allowed me to attend the pinning and hooding ceremony shortly after my arrival in town. It gave me an opportunity to connect with some of my fellow graduates in a more intimate setting, some of whom I had "met" in classes.

First was Bill, who had been in my Ethics class and hailed from Arkansas; I had enjoyed his sense of humor in the online classroom, and he was wickedly funny in person. Of course he was an ER nurse. He watched with envy as the Masters degree candidates milled about, carryng the hoods which were soon to be placed around their shoulders and remarked, "That's going to be me some day".

He had already started taking his courses in January; "Well", I said, "Mine will not be in nursing, if I do continue on for my master's.  If I never take another nursing theory course I will die happy. If I was younger I would go to law school". Bill, Erica who was a local, and I talked about what we would do with our shiny new degrees, the merits and challenges of a graduate degree, and when we would be receiving our honor cords for commencement. We wondered if there was any food around since it was mid afternoon, and most of us had been traveling since early morning. "They could at least have thrown us a couple of granola bars", Diane complained. She was a nurse I had gotten to know in Nursing Research; she was from Chicago. "I HATED that course", she said. "That instructor was brutal, then with two weeks left she up and quit!"

"I actually thought that was one of my better courses", I said, "but I took it right after statistics so I think it made more sense to me. I had one instructor who had a family emergency, but he was replaced right away so it didn't disrupt class. That is miserable to have an instructor quit like that".

Bill commented, "I took statistics at a ground school, and I did really terrible in it". The three of us discussed the challenges of online math courses, the reason my GPA was 3.91 and not 4.0. Diane had required a tutor for College Math; somehow I taught myself Intermediate algebra (there are rules, imagine that!) AND statistics.

Other classmates included Donna from Atlanta who was considering going on to be a nurse practitioner, but who's husband had died about 8 months ago; it was a bittersweet moment for her, and she was clearly trying to make the occasion as joyful as possible.  Mark from Tennessee was an OR nurse manager who didn't have much to say until he found out I came from the northeast; turns out we grew up about three towns away from each other.

The pinning ceremony was presided over by the Dean of the College of Nursing, who introduced the other nursing movers and shakers of the University. Her comments were personal and inspiring and made me really appreciate my nursing education, both my diploma program and the RN to BSN program that I had completed.

"Tomorrow, you will march in with your fellow graduates from a variety of different programs. Commencement speakers usually address their remarks to young men and women who have not yet begun their careers, however you, as nurses, are already experts in your field.  Continue to learn, grow, and mentor others".

I didn't mind that I was 4th from the end to receive my diploma, it was worth waiting for.

Thanks for the Access

2011-06-16T19:33:00.010-04:00

I was already suspicious when the patient listed Ultram and Tramadol as allergies (same thing).

Yet, today was the day that she decided to be seen in the ER for her long standing pelvic pain for which she had already been worked up. She had the pain for months and months. Her pain was no different than it had been for the last months even though she routinely took absolutely nothing for it. She had never called her primary care or GYN for follow up since her last million dollar workup for the exact same thing (without finding) nine months ago. Since she had a generous insurance plan paid for by you and me she obligingly submitted to the usual battery of tests:

Urine test=normal
Lab tests=normal
Pregnancy test= negative
Pelvic exam= some vaginal bleeding although she claimed she "didn't know she was bleeding since she had her period last week"
Pain relief with Toradol=not so much

The next plan was to send her to the Mother Ship for the obligate and gratuitous ultrasound which we do not have available on evenings. Or weekends. Or Mondays.

Although it is the SAME facility and we are merely an extension, for some reason we are required to do transfer paperwork. The nurse do this. And because we do NOT have electronic charting in this turn of the century (20th century) state-of-the-art health care environment, we have to copy everything. When we are also caring for other patients, this takes a chunk of time. Lastly, we have to call the nurse at the other ER for a report on everything we have done; safe Hand-Off. All this takes a good 15-20 minutes.

We usually leave the IV in place, just, you know, in case. The patient left with a boyfriend that apparently had waited in the car for all of the festivities.

Two hours later a call from the Mother Ship nurse: "Hey, that patient never showed up".

I HATE when they leave with the IV still in and none of their phone numbers work, and their address doesn't exist. It just creates paper work. I should have listened to my spider sense, it is rarely wrong. Damn.

"Can It, You Nit!"

2011-06-15T21:52:00.020-04:00

It as absolutely not, not, not necessary to relay every single, solitary, minute detail of your medical history when you come to the ER. It is also not necessary for us to know your background, education, likes and dislikes, job history, the kind of car you drive, ability to speak a foreign language, or if you are able to sign your name with your toes within the first 2 minutes of your visit. Trust me, if we want to know we will ask. During triage the information that is required is need-to-know. That is to say the information that I NEED, not necessarily what the patient is compelled to tell me. I am speaking about that all-important first bit of information the REASON FOR YOUR VISIT. It is most beneficial to be as succinct as possible, and least likely to piss me off.

New Cathy and I spent 15 minutes jointly trying to triage a woman who WOULD NOT SHUT UP. All we knew is that we had to haul her ass out of a minivan (and she was not a light weight...are they ever?) because of a knee or leg or foot or ankle injury. We had no idea because, again, she WOULD NOT SHUT UP, this bag of wind, bigmouth, blabber, blowhard, chatterbox, gasbag, jabberer, motor-mouth, etc, etc, etc..you get the picture.

Me: What did you injure exactly?
Verbose Patient: Well...(I am always wary of responses that begin witht this) THIS is my bad knee, I have had surgery on this one, well both of them really, but this one was never as good as the other one since I was hurt at work I am, well, was, a nurse and I worked in (can't remember what type of nursing she did) until 2 years ago so this was originally a work injury, but I have some arthritis in my back, but I've been getting around pretty good even though I can't work anymore....
Me ( interrupting) Excuse me, what is it exactly that you have injured TODAY?
Verbose Patient: My knee.
Me: Which one?
Verbose patient: Well I was looking for Windex, we are visiting my son and his family, we are on from Florida and like I said I was getting around pretty well lately, we made the flight from Florida fine, no problem, so the Windex was on a shelf but the shelf was down a few stairs and I didn't see the stairs and next thing I know I was in space and fell.

This went on for 15 minutes. I pride myself on being able to triage something like a knee sprain in no more than 6 minutes, and that includes individuals with 75 different meds and an equal number of allergies. Of course, her allergy list was predictably long and included aspirin, tramadol, all 'cillins, sulfer, six different antidepressants, milk, whey, strawberries, kiwi, any medication beginning with the letter "Q" or the number "7", snakes, air, dirt, rum, black magic, pirates, and clouds. All of which were, thankfully, on a computer printout that included every doctor's visit for the last 3 years so I didn't have to wait for her long-winded explanation on any of them.

I was fast running out of patience so I finally blurted, "you know, you're delaying your own care! You're the only patient in the department and could have seen the doctor 10 minutes ago....and already had an xray by now! Let's just have the Reader's Digest version for now, okay?"

Her husband burst out laughing; "Guess she told you! You always talk too much! Just answer the questions!". Little did I know that he was a windbag as well.

We eventually shipped her off to xray. The husband chose to stand in front of our desk and give us a 15 minute commercial for their over-fifty community where they reside. The golf, the hospitals, the restaurants; the types and prices of every house available, and on and on and on and on. I eventually excused myself and went out to the desk where I called New Cathy, just so she wouldn't have to talk to him anymore.

The wife was given a knee immobilizer, crutches and a prescription for Vicodin for her knee sprain. The Vicodin because she only brought exactly enough of her own Vicodin to last exactly the number of days she expected to stay in town. Oh goody.

At 6:00 PM I went in to fit the knee immobilizer, assess her crutch walking technique and give her discharge instructions, a task that should take no more than, oh, ten minutes being generous. Even for a completely uncoordinated yutz. I said to New Cathy, "It's six o'clock; I'll bet I won't be done with this discharge until 6:45 PM. At the earliest".

It was exactly 6:40 PM when I shut the door of her minivan, two hours from start to finish. She would have been in and out in less than an hour from start to finish if she would have just SHUT UP. Thank you.

Dear Parent, an Open Letter

2011-06-11T20:18:00.001-04:00

Dear Parent,
First of all, I want to congratulate you on your adorable children; all six of them. I can't see that many of them resemble you; perhaps they take after their father(s). How nice that you have brought them all with you tonight so that you could get that painful bunion examined. I know what a chore it can be to make doctor's appointments for yourself when you are so busy; it is no wonder you haven't had any time in the last 3 months it has been bothering you.

I regret that I am unable to feed / water / toilet / or otherwise entertain them. I would give you a book to read to them while you wait, but since you assured me that TV takes care of all of their literary needs there is no point.

They certainly are a spirited bunch, aren't they? Not everyone is as effective in your style of free-form parenting; they sure don't like to hear the word "No", do they?

I would like to just point out that making a fort out of the waiting room furniture isn't the best idea since many of our other patients would also like to sit down. Out of common courtesy, perhaps you could remove one or two of the younger children so that our elderly patients also have a seat; I know you were there first, but I am merely suggesting it as a token of good will towards others. Think of it as a teaching moment.

In addition, I regret to tell you that your children, while enthusiastic, have no talent for origami, so would you please discourage the destruction of EVERY magazine? Yes, they are old, but we have a limited selection as it is.

I have, in conclusion, one small request that you refrain from referring to your children as "little bastards; I understand that is a term of endearment, but the majority of our clientele don't see it that way.

Again, thank you for sharing your delightful children with us today.
EDNurseasauras

An ER Match Made in Heaven

2011-06-10T13:20:00.002-04:00

Kate and I hosted a remarkably busy night, notable for the overwhelming idiocy of the clientele. Same crap, different day.

The 17 year old boy walked in with his mother and stated, "I broke my hand".

Me: "What happened?"

"I got pissed off about some shit punched a fucking wall in school. I've done it before"

Me: "Charming". Note that it is 9 PM; the incident occurred at 1 PM.

Ten minutes later, a 15 year old girl comes in with HER mother with a similar hand injury.

"I punched a door"

What a delightful pair; I put them both in the waiting room until they had been xrayed since I had bigger fish to fry. Fish that didn't punch walls. The two apparently struck up an immediate and life long relationship based on their mutual interesting hobby of self-mutilation.

I overheard the boy: "Yeah, I came in for a cast"
Girl: "So, you broke your hand? What happened?"
Boy: " I punched a wall"
Girl: " Oh, weird. Me too!"
Boy: " Wow, we have a lot in common".

Me: (to myself) Please do not let them breed.

There were no broken bones, just to be clear. Now, where did I leave those fliers for anger management classes?

Stuff I See on the Camera

2011-06-09T17:38:00.012-04:00

MANY people have no idea, although the warning is clearly posted, that we have surveillance cameras which cover about a dozen views of the building both inside and out. The real-time display on our computer can be programmed with our favorite views; everyone has their own. My own particular choices include the two front parking lot views which cover the ambulance bay and the walkway to our patient entrance, the waiting room, the inside entrance to the patient door and the outpatient registration area. Once I saw a cat so big walk across the lot I though it was a fox. I have seen a family of skunks walking across the back parking lot; this was a revelation, I did not know that skunks travel in packs. Do skunks spray other skunks? Do they, too, find the odor noxious? Curious...

I love observing people and catching them n the act of doing something ridiculous. I have spoken about people who leave with the Miracle Cure: the lame who walk without a limp, the bent-over who walk upright. I submit for your amusement those who appear to misrepresent their maladies for whatever reason. The most common is, of course, drug-seeking, followed by work avoidance/workman's comp claims, and attention seeking.

One young man and his female companion were observed walking across the parking lot. They paused in front of the walkway to the front door patient entrance, crouched, and enjoyed a cigarette while remaining in that position.

Between the end of the cigarette and the walk in the front door, the young man developed a pronounced and painful-appearing limp. He had been seen 3 days earlier for knee pain and his Percocet was gone.

He didn't get anymore because it was pointed out that we have hidden cameras. He stormed out threatening to call his lawyer and crying bullshit.

Another gentleman was observed getting out of his car, leaning against it and having a 10 minute or so cell phone conversation. He gesticulated, paced, and otherwise seemed to be in control of himself.

Then he walked in the door holding a bloody handkerchief to his eyebrow, moaning and groaning dramatically. I asked what happened between the end of his phone conversation and his walk into the department to make him so miserable: had he been attacked by wild dogs perhaps?

"You have cameras?"
Um, yeah.

One couple stood right under the camera making out for the longest time; I really wanted to tell them to get a room. When they finally came in, the woman was having 10/10 abdominal pain. She wanted a work note.

One guy proceeded to wax his car while his girlfriend was being seen for a wrist injury. When she left with a wrist splint, she took the wrist splint off and helped him finish his waxing.

I worked a day shift (shudder) and saw that a police car, lights a-flashing, was in the front lot. The officer was applying handcuffs to the driver of a car that had pulled in ahead of him. When backup arrived, the second officer advised us that the car would be there for awhile, and the animal control officer would arrive shortly to take custody of the detainee's dog. Said dog was to remain in the car: Sit. Stay. It being a hot day, I was more worried about the dog, but animal control arrived promptly and he, too, was hauled off to jail.

Early in the spring, one woman sunbathed on the hood of the car. In a bathing suit top. Do I REALLY need to tell you that it wasn't a pretty sight? Hmmmm?

I watched a girl come in for a wheelchair because her boyfriend had "a really bad leg injury and couldn't walk". He, like so many, was observed walking around the car in a perfectly normal manner, and take a carton of cigarettes and a gallon of windshield washer fluid out of the trunk. I though he was going to drink it, but he popped the hood and casually poured it in BEFORE he sent the girlfriend in for the wheelchair.

Better than TV.

Just Shaking My Head

2011-06-08T22:30:00.001-04:00

One of our frequent fliers with a host of chronic, pain related and narcotic-seeking complaints came by with her 30 year old son. His complaint today was back pain, shoulder pain, leg pain, leg numbness, knee pain, neck pain (from no trauma that he could recall), and dental pain. Really. Sonny has apparently not been able to work since he was 18, had no insurance, no job, no doctor, and nobody to grease the wheels of government sponsored care due to his inability to work. And that, my friends, is the real reason for his ER visit; per mom, "He needs to have this documented and fill out forms or whatever and get him serviced (her words, not mine). Somebody has to do something for him!"

With all of these chronic pain issues and his 10/10 pain, he is on no meds. Takes no pain meds, not even ibuprofen or Tylenol. I took a look at his old record to see if his past visits were as numerous as I suspected. I was pretty shocked that he had NOT ONE ER visit since 2006 for a sore throat.

Well, well, well. Interesting.

The Talker spent a good long time with Ma and Sonny. They left with a prescription for Tramadol and the social worker's card. What was the story?

As I suspected, Sonny couldn't seem to hold a job, although he has had plenty. In fact he had worked today at the Happy Mart pumping gas.

"So what was that bit about not being able to work in 12 years?", I asked.

"Well, it's not that he hasn't been ABLE to work, but other issues have precluded his ability to WORK WELL", answered the Talker.

"Like what?"

"Oh, sleeping late and not getting to work on time because he was out late with his friends. Just not feeling like working. Not liking to work on weekends. Being hungover. You know, all the usual issues the rest of us struggle with".

Um, yeah.

Arrrrrrrrrrgh

2011-05-24T12:37:00.001-04:00

Billy was brought in by his mother with a really nasty laceration through his eyebrow and into the eyelid. He had stepped on a water bottle, lost his balance and fell while on his deck, busting through the railing he broke en route to the backyard four feet below. Amazingly, he had no loss of consciousness. Billy weighed 250 pounds at 5ft 4 inches. That he did not break his neck is likely attributable to the 8 or 9 beers he had consumed during the course of the evening. His list of medical problems included high blood pressure, chronic back pain, more chronic pain issues. Billy was 46 and lived at home. I would add alcoholism to his list, but that's just me.

I have absolutely no idea how Mrs. Billy's Mom got him to the ER on her own, but she deserves some serious props. Hope she had a GREAT Mother's Day.

Billy moaned and groaned and moaned and groaned. Then he groaned s'more. To quote Dean Wormer, "fat, drunk and stupid is no way to go through life, son". Nor is living with your mother at 46.

Billy's biggest concern, though, was how much of a scar his laceration would leave; Bobo said he would certainly have a scar. I advised Kate that she better grab this one before he was snapped up; quite a catch.

Billy: " yeah, how big a scar do you think?"

Bobo: "It's difficult to say"

Billy: "Well, how would it compare to these?"

Billy lifted his shirt and displayed some impressive scarring on his equally impressive gut.

Bobo did a double take. "What are those from?"

Billy: "Well, I got shot here, stabbed...stabbed again...I ran with a pretty rough crowd when I was young"
Seems more like the crowd ran over him.

Bobo scrutinized the jigsaw puzzle on Billy's torso and indicated the scar on the left side of his chest: " Wow, looks like the gunshot there just missed your heart"

Billy: " Yep, I'm lucky to be alive. So, how about that scar; I have to be looking good for the ladies"
Bobo: "Probably not that bad by comparison"

Um, yeah. I am thinking he might just be able to pull off the pirate look when Billy nodded with approval.
"Yeah", he said, "the ladies will love that".

We sent him to the Mother Ship for a CT scan, which turned out just fine. While there, he asked the unit secretary out.

Um, yeah. See, I told you Kate, that kind of merchandise doesn't stay on the shelf long.

New Gal

2011-05-23T19:54:00.013-04:00

Mikki is gone. Goodbye to her as she heads off to greener work pastures. Just remember there are no utopias in nursing, anywhere. I am not sure that there can ever be a utopia in endoscopy where she headed. For me, it would be the tenth circle of hell to spend all eternity (or until the end of my nursing career, possibly one and the same) as a bum look-up nurse.

So, Southern Cathy has taken Mikki's day shift position, and I have a new partner imported from downtown: meet Kate. She is disgruntled with the lack of leadership and general fuckery at the Mother Ship and is happy to roost with us. Welcome, Kate!

She and I have similar backgrounds and experience and an eerily similar sense of humor; quite scary, actually. We laugh a lot. Bobo is doomed when we are both working, it is quite entertaining.

If our first ten minutes together on shift is any indication, this looks like the beginning of a beautiful friendship.

I had triaged two individuals named Steve back to back. Ellen is slow to register, so I went looking for their charts to bring them into a treatment room.

Me: "Hey, did Ellen bring those charts back? I want to bring those two patients in"
Kate: "Ellen took them; she's bringing in the Steve's"
Me: "Bringing in the Steve's?"
Then I sang:"Bringing in the Steve's,
We shall come rejoicing"
by now Kate had joined in,
"Bringing in the Steve's!"
Then we laughed like idiots.

Kate: "What is a sheave, anyway?"
Me: "I think it is the little plastic piece at the end of a shoelace".
Kate: "Of course! Shoe lace sheaves! Brilliant!"

Yep, Kate is gonna work out fine.

National Shortage

2011-05-21T22:56:00.006-04:00

You won't see this on any newscast. It is a secret known only at the highest levels of government.

There is a national shortage of mirrors.

There has to be. I mean, some of the stuff people are wearing when they leave the house...it HAS to be that there is just no access to a mirror to see how they look.

Really??!!

It is the only reasonable explanation. Unless people are in possession of magic mirrors in which they see only what they want to see.

Here are some helpful hints for the mirror deficient:

If it feels tight, it probably is. That doesn't mean that you have the figure to wear it.
It you bought it in the sleepwear section, get dressed in actual clothes before you leave the house.
If you cannot button your jeans, you need a bigger size; perhaps several sizes. Really.
If you are not pregnant and cannot see your feet, please refrain from wearing a tank top.
Bra. 'nuff said.
Short shorts: just....don't. Please.
If you have legs that look like potato stix (thanks to Sue for that characterization), leggings just really aren't the look for you
If you must walk near the railing on the upper level of the mall and are wearing a skirt, you should really consider wearing underwear.
If you are male and wearing a shirt that says "It's Not a Beer Gut, it's a Fuel Tank for a Sex Machine", you have no hope of a normal girlfriend in the near future.

Dear Narcotic Seeker, an Open Letter...

2011-05-14T11:55:00.004-04:00

I see you have had a number of visits for your Holy Trinity of Chronic Complaints (dental pain, back pain, migraine). I make no apology for placing you in the waiting room. Just so you know, the medical professionals upon whom you depend for your endless supply of prescriptions for Percocet are busy with actual emergencies today. Two happen to be busy trying very hard not to die, one before we can get a helicopter here to transport her to Big City Hospital.

Ellen, our secretary to whom you give the same information every time you come in, is busy trying to assist the professional staff by making phone calls and other duties since the nurses are up to their assholes in alligators. It is inappropriate for you to lie on the floor in the waiting room and moan for a blanket. Frankly, we just don't care what you do or how much you act like a total douche; however, you are a distraction for Ellen, and you are making the small children and your fellow douchetards in the waiting area uncomfortable.

If you sit in the chair like a grown-up and behave yourself, you might be seen by the doctor in the next two hours. You might get one Percocet if you are a good little narc-seeker; however, telling me "Kiss my ass!" is not going to endear you to anyone.
With Disgust,
EDNurseasauras

When Stupid is Not a Concealed Weapon

2011-04-30T12:40:00.003-04:00

New Cathy and I worked last weekend and I think we might have seen about 10 patients total, which amounts to DEADLY slow shifts. Wednesday, Thursday same thing. I managed to read about half of "1984", which I can't remember having read in high school but know that I did; I picked out lighting for my new kitchen and did most of my schoolwork for the week. And was bored out of my gourd, having to resort to watching a rerun of a ridiculous singing version of Gray's Anatomy; we saw in total 5 patients in 8 hours. All that quiet we have more than made up for in my last few shifts; it has been pants crappingly busy with actual REALLY SICK people.

I like to work with the Talker, he doesn't hurry people, which is why they love him. He has no urgency to to boot them out the door no matter what the complaint. This goes equally for dental paineurs (they get antibiotics only if they have more than one visit for same), antibiotic-seeking mothers whose kids have had a temp of 99 degrees for 10 minutes, back pain (chronic), and not-magically-better boo boos and viral illness after 12 hours.

Of course this can backfire when it is really busy. He largely ignores Bobo's mandate that all patients be seen within 20 minutes. Sometimes it is as much as an hour. Or more. It gets complicated because the Talker doesn't automatically get xrays or order labs simply because the patient expects it; it is definitely not "Have it Your Way" ER when he is on. If it will not affect how he will treat the complaint, he is all about not exposing patients to radiation or paying tons of money for lab work. Have a UTI? We dip it, he treats with antibiotics. The common sense approach rules.

There were about 7 patients sitting in the waiting room; Ellen was buzzing around, dealing with a lot of non-emergent whining "how long is the wait". This really bothers her because she hates to ask us when we are busy, and is just not hard-wired to be firm with the idiots. Generally she is stuck in the middle where she never wants to be.

At 9:30 PM I looked over the charts in the rack:
Cough x 1 week in an 8 year old. Not worse, just not better.

"Asthma attack" in a tween girl (drama, drama, drama). Not wheezing, not coughing, not short of breath, sats 100% on room, lungs clear. Take a number honey, and get off your fucking cell phone.

Vomiting x 2 in a 20 year old frequent flier female who has been seen 8 times for "menstrual cramps" and always gets vicodin. WTF. Does not look sick and is drinking an iced coffee

Laceration in an 18 year old male. Microscopic. Will not require stitches.

"Flu-like symptoms"; nausea, no vomiting, no fever, no cough, no other symptoms except "I don't feel good". History of fibromyalgia.

Dental pain, first visit for same; accompained by 23 year old boyfriend who has had innumerable visits for same

Dental pain, 10 visits between the us and the Mother Ship. Known to have altered a presctiption in the past.

Of the patients in rooms and getting workups, two were being admitted with all the bullshit that entailed. At least they would be gone by 11 PM. One is getting antibiotics for cellulitis and is ready to leave. One is awaiting disposition for a UTI. Two kids with earaches waiting to be seen. The Talker usually doesn't prescribe antibiotics for all earaches automatically.

He spent 20 minutes in a circular argument patiently explaining to a woman who was strongly advocting for her 24 year old daughter for antibiotics for yet another viral illness.
"But we had them last time"
"She is not better so she needs them"
"If she doesn't have antibiotics how is she going to get better"
"But she had them last time and got better"
"She is sick, so she needs antibiotics"
"Couldn't you just give her some samples"
"She needs antibiotics because she is sick and not getting better"
"We will just come back tomorrow and get them"
You can't win any of these arguments when people are stupid

It may be time to start looking around for a new job. At least in a regular ER, most of this time-wasting crap and parade of idiots would go to the fast-track. Where I never want to work.

Blast from the Past

2011-04-28T13:45:00.006-04:00

I was flipping through the channels just now and came across an episode of "Marcus Welby, MD". This show is a time capsule of stuff that happened in the 1970's when I went to school. Get a load of those caps and white uniforms! Of course, the nursing stereotypes were pretty extreme.

I can't say as though all of this was the norm because I trained at a pretty progressive teaching hospital. Well, marginally more progressive than most I guess. "Natural childbirth" was hip in 1975, and fathers were part of the birth team functioning as the labor coach. But, only if the couple was married; no "baby daddies" allowed at that time.

This episode took place in 1975 and featured Gena Rowlands as a 36 year old professional woman, busy, successful and having it all except a baby; she had been struggling with infertility for years. In real life she was probably 45 and looked it.

Upon declaring her about four weeks pregnant, the mother-to-be phones up the husband to tell him the ecstatic news. The proud papa rushes over to old Marc's office with champagne, whereupon ALL THE DOCTORS, NURSES, HUSBAND AND PREGNANT WOMAN COMMENCE TO DRINK. Yikes.

A group of pregnant women, Marcus Welby's nurse and a couple of nursing students take a tour of the "Maternity Ward". First they get a look at the labor room, where "a nurse will help you time your contractions for the first stage of labor". Guess L&D nurses didn't have much to do in those days, at least until it was time for delivery.

Next, the group of scared looking women, clad in white OR gowns and caps moves on to the delivery room "where you will be moved for your second phase of labor". Scary damn place. "This is the table where you'll bring your child into the world!" Nurse Lopez says brightly

"Where do we first get to see our baby, Miss Lopez?", asks a scared primip.

Nurse Lopez looks strained, takes a breath and says, "Well, maybe in here Susan...if you're awake in time. You may be just under a local anesthetic if there are no complications. Then, you'll hear your baby's very first cry right in here". Camera pans to incubator, OR green-covered equipment, stirrups and scary shit as the young mother looks terrified. "Something to look forward to, isn't it?", Nurse Lopez asks gently and unconvincingly. The group is ushered out, no doubt to view other medieval implements of torture.

The rest of the show is pretty crayzee, but I don't have time to see it. I'll DVR it for later.

Stubborn, all of them

2011-04-24T23:56:00.003-04:00

I thought some of those tough old Yankee birds were a trial when I lived in Massachusetts; they were nothing compared to these stubborn NH Yankees.

I got a 70 something year old man by private car for "trouble breathing", who needed a wheelchair assist from the door. He was gasping like guppy; his O2 sats were in the 60's. According to his daughter he had been having increasing shortness of breath for about a week. He wasn't eating or drinking, and couldn't get off the couch for the last couple of days. His daughter said "He has emphysema and his inhalers aren't working. He has refused to come to the hospital, and wouldn't let us call an ambulance; I had to call my brother to help me get him out of the house when he finally relented".

No shit. He was frail and cachectic, a bearded, grizzled old guy. He was not on home oxygen. He did not have nebulizers. And he continued to smoke (until a few days ago).

"He refused nebulizers and oxygen, well, he is a smoker so even if he didn't refuse it he would probably blow himself up or start a fire".

We managed to turn him around without intubating him, but it took awhile and he was pretty tired. I assumed he would go to the ICU, but apparently the hospitalist didn't think it was necessary. WTF. The doc was a stubborn as the patient

Our doc was Arnie,who only works with us one or two shifts per month; in four years I have probably worked with him maybe 7 or 8 times. I appealed to Arnie that, c'mon, he needed a higher level of care than can be provided on the medical floor. "I think he'll be ok".

Yeah, right; time for an end-around.

I called the nursing supervisor and told her that even on 100%, he desatted to the 80's with minimal exertion and in my opinion, nurse to nurse, (code for the doc doesn't see it that way) he was not appropriate for the floor. She agreed. But, since nurses are considered idiots who can't make decisions at this joke of a hospital we had to play games; nursing supervisors at this religious institution being all female don't have much influence.

We decided to have the hospitalist see the patient in the ER but still keep him a direct admit. Cripes was the doc downtown and was also given the heads up. His wife is a nurse and he is one of the few who actually thinks nurses have anything to contribute.

"He's going to the unit", said Cripes. "Cripes, he's on a non-rebreather!"

Yep.

I took the shotgun approach to report and faxed it to everyone; the ER nurse I talked to.

"Oh yeah; he's going to the unit".

Like I sad.

This Could have been bad

2011-04-23T12:05:00.006-04:00

Telephone caller: "Hi, would it be possible to get rabies shots there?"
Me: "For humans or animals?" (I wasn't being a wise ass, really)

A while later, a woman came in who stated that she had been bitten by a skunk; well, that got my interest.

The middle-aged woman had been raking in her back yard and didn't notice the mangy, dirty skunk until it was right beside her. At that point, she was too afraid to move and scare it into spraying her. Unbelievably, the skunk sort of rolled on her foot; then bit it. It wandered off and then sprayed.

Not normal skunk behavior for sure, and it occurred at 4 PM when it was still daylight.

Fortunately, the patient was wearing a heavy boot at the time; the skunk never broke the skin, luckily for her. She skated off without getting rabies prophylaxis after our doc got some advice from the state Board of Health.

The skunk was not found according to police.

What?

2011-04-22T12:32:00.003-04:00

For some reason, I had a high school student intern one day last week. I thought it was very odd since high schools are usually trying to accomplish internships early in the school year. Plus, my boss Jane was on vacation so I had no idea she was coming.

She was very quiet. Painfully quiet. It was an effort for her to get out her name.
"Annette", she whispered after I had begged her to repeat it three times; she looked about 12 years old.

"So, are you planning on going to nursing school?" After thinking for awhile, she responded with a barely audible, "Medical school".

It was a long four hours. She did not initiate conversation; she only responded to my questions after struggling to come up with an answer. I have never met anyone so pathologically shy. I found out she is going to Big Boston Institution of Higher Learning, (BBIHL) having achieved early acceptance. Talk about jumping into a shark tank wrapped in a Lady Gaga meat suit.

I took her into triage with me a few times, but since it was a pretty quiet night (as it usually is when we have a student) I just stopped trying after awhile and read a journal. I was kind of relieved when she left. I always ask students what the most interesting part of their experience was in order to put it in some kind of perspective, or get some of my own as to how to improve the experience for the next student. Annette responded: "Nothing".

Jesus tap dancing Christ.

Jane and Second in Command and I were finishing up a little business at the start of the shift and Annette came in; crap, not again. I greeted her and introduced her to Jane; I directed her to put her things in our back room.

Jane looked at me quizically; "Who was that?"
Me: "Student. She was painful the other day, could barely get a word out of her"
Jane: "She looks like she's about 12! Is she even in high school?"
Me: "Yep, graduating in June. She's been accepted to BBIHL and she wants to go to med school"
Jane: "Holy Crap! She'll get eaten alive!"
Me: "I know, she will never survive orientation"

Nothing rattles the Talker. Usually.
There are always exceptions. He is good with teaching, but I could see that he was having difficulty conversing with Annette.

"So, is any one in your family in medicine?"
"No".
"So, what made you decide to think about med school?"
After thinking for about 20 seconds, "To help people?"

He asked a lot of the same questions I did, and I had to squeeze my lips together to keep from answering for her, it was that uncomfortable. It was a little busier so we at least had some things for her to see.

We had her watch the Talker put an orthoglass splint on a little girl with a fractured wrist. He explained everything, showed her what he was doing, gave her a piece of orthoglass play with. She was silent; the Talker just looked helpless.

I had a thought that maybe her guidance counselor should have given us some kind of heads up on this one; not all fragile people come equipped with a "Handle With Care" stamp.

Annette planned to spend her final four hours of her mini-internship at the Mother Ship. Yikes.

Walk This Way

2011-04-21T12:10:00.006-04:00

The Lady on Elm St. has been suspiciously quiet lately. There are some ER docs that she just doesn't like. Let's see, that's....everyone except Cripes and Henrietta.

Lady arrived by ambulance with her usual abdominal pain complaint. She was brought to us in spite of Lisa's advising them over the radio that "Dr. THE TALKER strongly advises that this patient go to the Mother Ship for evaluation".

That is because Lady and the Talker do not get along. The Talker finds it necessary to tell it like it is; Lady finds it necessary to take offense. The Talker has been known to remind Lady that her morbid obesity is a hazard to her health; Lady has written complaints about the Talker since her morbid obesity, in her opinion, is none of his business.

Whatever the Talker said this time caused Lady to storm out of the ER; if a person of her sizable girth and wearing a nightgown, robe, and fuzzy slippers can storm anywhere.

Lisa waited awhile and then, when she didn't return, called the police to see if they could see her. It was a long walk to Elm St. Surprisingly, she had called someone to pick her up and it wasn't an ambulance.

The Talker expects another letter of complaint. I expect Lady to come in on my next shift.

What, Me Worry?

2011-04-20T10:55:00.005-04:00

You have probably noticed the "Days 'til Gradution Ticker" to the right over there. Yes, I am finally, actually, really finishing. My course ends officially on May 4, but I expect to have all the necessary work finished before then. It is a PAINFUL course; Holistic Professional Nursing. Really, it is just Public Health Nursing redux. Same book with the same professor; and the same no-nonsense attention to detail.

Bwa-haha-hah-hah-hah-hah-hah!

It is an 11 week course. I have, on average, two discussion questions weekly and an installment of the Capstone Project. To date, I have passed in every single assignment late, copied and pasted the same response to a discussion four times (with minor tweaks), and lifted entire sections of papers I had written previously to fulfill an assignment. I have a 100% average in this class in spite of copying the Gettysburg Address and citing Alfred E. Newman and Mad Magazine as a reference. "Great job! Keep up the good work!". Yikes.

The entire class is in the same boat; we are all suffering from, dare I say, Senioritis. My kids know what it is like to be a SEEEEEEEEEEEEEEEEEEEEEEENIOR. I guess we are all grateful that we have the most laissez-faire instructor on the planet for our final course

About friggin' time.

Mr. Ednurseasauras, my biggest cheerleader, is thrilled (we really haven't talked about grad school). My boss is overjoyed (she is encouraging grad school, but I think for now I prefer to get my kitchen renovation completed and tackle that next fall/winter). Nana wanted to go to my graduation (in June, in Georgia, where it is very hot) but thought she would enjoy staying home and minding Tina instead; they get along great, and Tina LOVES going to visit Nana). My kids, K and J, having finished college 8 and 4 years ago respectively, have always been in my corner, gave back to me those words of encouragement I spoke to them when they were taking their academic journey:

K: "Mom you are so close!"

J:" Just think about how good it will feel when you are done!"

K: "Party!"

J: "No more college tuition"

K: "Now you are a SEEEEEEEEEEEEEEEENior!"

J: "I guess you will be wanting your Kindle back" (I let him borrow if for an extended period while I finished school; it was a distraction otherwise)

I plug away, and look forward to not having anything hang over my head in a couple of weeks. So close, so close. But first, I must write up the intervention on a family I made up for Smoking Cessation; although made up of various people, they are not a family. The matriarch really did light up a butt while she was on oxygen, hilarious hijinks ensue. Not. I think I will throw the Bill of Rights in the middle of it and cite Wikipedia just to see if my professor is paying attention.

Parenting is Only a Part Time Job

2011-04-19T23:34:00.005-04:00

We were having a nice, steady night with Brian. Brian works quickly and unfailingly manages to get all of his dictations done right after he finishes with the patient's care. This strategy assures that when 11 PM rolls around and there are no patients, he is out the door. Works for me.

We had already sent two patients with abdominal pain down to the Mother Ship for CT scans and seen three garden variety frequent flier dental paineurs who got antibiotics and Percocet (the only thing I really don't like about Brian....it's like feeding squirrels, they always come back for more). He had put Orthoglass splints on two little girls with buckle fractures and it was only 5 PM. Wham, bam, thank you ma'am. In and out.

My next triage was a plus-sized young woman with 10/10 abdominal pain that she had been having for the better part of a year. No other symptoms. No insurance. She was supposed to have followed up with her gynecologist, but apparently paying for her artificial nails, her IPhone, and her Coach bag were more important.

Me: So, what is different about your pain level today?
Pt:: I just thought it was time to do something about it.
Me: Uh huh.

The woman had with her an adorable 3 year old whom she consistently parented poorly.

"Sit down. Sit down! SIT! RIGHT NOW! What did I tell you? Do you want mommy to spank you? I told you...no, Aaron, don't do that! Get down off there! What did you...did you just put something in your mouth? Spit that out! How many times do I have to tell you to....come here....come over here right now.....AARON! GET OVER HERE! You are such a pain! I can't take you anywhere! AARON! Are you listening to mommy?"

Clearly he is not.
Aaron continued to terrorize the treatment room, and all we could hear was mom yelling at him behind closed doors. Brian ordered some of the usual tests; pregnancy test, urine, etc, but I knew the pelvic exam was coming, and I tried to mentally prepare myself. I was having some trouble with that, though.

To Brian: " I would rather have you professionally poke out both my eyes with an 18 gauge needle than chaperon you with that pelvic exam".

Brian, laughing: "I know, I'm not looking forward to it either".

When the time came, Aaron had parked himself on the stool at the business end of his mother. He could not be budged, not even with the Beanie Baby that we keep for emergencies. Brian got tired of coaxing darling Aaron, so he finally picked him up and deposited him on a chair; he immediately scrambled out and stood, again, in a posture of interest in front of his mother's crotch.

Me (to Brian): "Is he trying to crawl back into the womb?"

Brian finally just nudged him out of the way and did what was necessary.

She left with Vicodin. Yikes.

I understand that not everyone who gives birth is an ideal parent, in fact some are downright appalling as evidenced by the number of screwed up kids in the world. But this just bothered me. Having children is enough of a crap shoot as it is even with good parenting. I just couldn't help but think that this kid is doomed.

Manic Marathon Monday

2011-04-18T11:49:00.000-04:00

I'm sitting here watching coverage of the Boston Marathon on TV while avoiding schoolwork and Tina-walking. Pretty crayzee stuff, that. These are super human beings. I have friends who have worked in the medical tent at the conclusion of the race, but have never done it. It might be fun to do sometime, though.

Years ago when I worked at an ER close to Boston, we would occasionally get a Boston runner hours after the elite runners had finished. These runners were not world class, but had run their race in 4, or 5 hours and had muscle cramping or dehydration. It was fun to hear about the start in Hopkinton.

About 8 days ago we had a gentleman who had fallen in his yard and opened up a nasty gash on his knee. He was training for Boston.

The Talker and he bonded over a mutual love of running while he stitched the wound. As I bandaged it with my usual somewhat bulky first dressing, the patient wondered how he was going to run with it next day; with 8 days to go before the marathon, the distance running was done and now he was doing shorter training runs.

Me: I imagine that you would be putting a big band-aid over it if you are running tomorrow, hmm?

The patient laughed and admitted that was his plan. That's ok, it's his first marathon; it is a big deal for New Englanders because the weather is such a factor in training. We had a most miserable winter in New Hampshire, so I can imagine the adverse conditions that he faced. He was not going to let a little laceration stop him.

We wished him luck and, as always, invited him back for (free) suture removal in 10 days. I've been looking for him, but since he is not an elite runner I will not be seeing him on TV. I hope he does well.

Goodbye, Mikki

2011-04-07T16:40:00.019-04:00

Well, Mikki quit; she's moving on to be a bum-look-up-nurse in Endoscopy full time for a little bit of money but no nights, weekends or holidays. I would rather work at Chile's, frankly, but it is a good move for her. Naturally the vultures are fighting over her day shift hours. They can have them; I hate working days, given that SIC is about to become even more unmanageable. Jane has taken on some added responsibility and will be helping out at the hospital's version of VNA (visiting nurses) to get their dismal leadership situation in hand. Yeah, good luck with that. Jane hates confrontation. Me and the other cool kids have vowed to quit en masse if SIC is given any responsibility that even whispers at a management role.

So, we on the evening shift will be acquiring a new player. The rumor is that it will be someone from the Mother Ship. Is it me? I lost one co-worker who died, my work husband quit, now this. Perhaps I should buff up my resume.

Both Cathys, Sherry, Mikki and I went out to lunch to wish Mikki bon voyage and good luck with her new job; Kerry and Lisa were both working. We did invite SIC but she chose not to come.

I will miss Mikki. But it does put me first in line for getting July 4th off.

Some Things Can't be Unseen

2011-04-06T17:07:00.020-04:00

Kerry called me on my cell the other day while I was driving and caught me in a weak moment; could I PLEASE work 4 hours on Saturday morning so she could go to her son's playoff game, pretty please, please, puh-leeeeeeeeeeeeeeeeeze???! Sigh. OK. At least I got to work with Lisa who is funny as hell; we are a bad combination attitude-wise but usually manage to have more than a few laughs. What I didn't count on having to work with Parvati, who is painful to work with and who just feeds into people's drama unnecessarily. "WHAT? YOU HAVE VOMITED ONCE AND BEEN SICK FOR 15 MINUTES? YOU NEED IV FLUIDS AND LAB WORK TO MAKE SURE YOU ARE NOT DEHYDRATED!!". Um, no. You really don't. What you need is a prescription for common sense. With Parvati, everyone is treated as if they really ARE as sick as they think they are.

Like Whiny Cough Lady ("I have really bad roll-y veins.....do you have to put the IV there?....IV's don't ever hurt me that much..... can I have another straw?.....I don't liiiiiiiiiiike being siiiiiiiiiiiicccccccccccck......Don't you think I am the sickest and most pathetic creature on the planet who had bronchitis everrrrrrrrr??!!). Bleecch. She really didn't need to tie up my last remaining bed for two hours; didn't need any of that. What I needed was a bed for a teenager with a broken ankle. We are an ER, not a hotel.

Then there was Migraine Lady #1, 298 who was apparently put out that her 10/10 headache was not treated immediately with Dilaudid. She walked out prior to the completion of her care without a word to anyone, although she got IV fluids, Toradol and Compazine. I did all the things I was supposed to; offered her crackers and juice, took her vital signs, dimmed the lights, got her a toasty warm blanket or three, and reassessed her pain after I had medicated her. Too bad she left, because Parvati had just written an order for her to have her much desired narcotics. She scarpered when I was busy with an overdose, but unfortunately with the IV still in her arm. Her Skanky Neighborhood phone number was.....disconnected, surprise, surprise. Oh, no work number because she is unemployed. Ah, no insurance so you and I will take the hit on this.

But it is bad when people leave with IV's in their arm; liability.

So I called dispatch to see if they could send a police officer or animal control officer to politely ask her to return; we really don't want IV drug users running around unsupervised with expertly and hygienically placed venous access. Not that she was, but still.

Me: 'Hi, this is EDNurseasauras at the ER. One of our patients left with an IV in, her phone number is disconnected and I was hoping you could send an officer to her house to encourage her to return for its removal"

Dispatch: "Sure, no problem. What's her name and address?" I gave him the particulars; he said he would get back to me. We heard the call go out on the scanner. A short time later, the dispatcher called me back:

Dispatch: "I guess she hasn't made it home yet; what was she wearing?"

Me: "Is this a recorded line?"

Dispatch: "No, it's not".

Me: "OK, good. She was wearing a horrendous neon pink jogging suit, the likes of which should never be seen in public, never mind being displayed on a woman that size"

Dispatch: (muffled laughter), "OK, um. Ok. Hold on.. (more muffled laughter). Is it pink on top and bottom?"

Me: "Yes, except for the parts where the material doesn't cover the tattoos on her muffin top"

Dispatch: (strangled noise, muffled snorting), "Um, OK, sure. I'll send and officer to see if he can spot her on foot".

Me: "Shouldn't be too hard to miss".

She never showed up, another big surprise.

Jane calls all the patients who leave before they are discharged; most of the time it's because the wait is too long, or they have to pick up their kids, or they see who the doctor is and realize they will probably not be getting any Vicodin this visit. Migraine Lady said "we were mean to her and didn't care about her pain". Translation for the uninitiated: "I didn't get any @%^&!ing narcotics!"

Jane: "Oh, it's too bad you left before getting the Dilaudid that Dr. Parvati prescribed for you; the ER was very busy at that time with a critically ill patient that, unfortunatley tied up the nurses; sorry for the inconvenience. Hope you feel better, have a nice day".

Translation: @%^&! off.

Slipper-y Slope

2011-03-24T23:34:00.009-04:00

I just don't tolerate being yelled at, especially on the phone.

Some old guy who had left the department with his wife about 10 minutes before I got there called, all agitated.

"I AM AT THE END OF MY ROPE! YOU PEOPLE CALLED ME AND TOLD ME MY WIFE LEFT HER SLIPPERS AND I COULD PICK THEM UP AT THE FRONT DESK! SHE HAD THEM WHEN SHE LEFT THERE IN THE AMBULANCE; NOW NOBODY KNOWS ANYTHING ABOUT IT! I NEED TO TALK TO LISA, SHE TOOK CARE OF MY WIFE TODAY! ARE YOU LISTENING? I CAN'T LOOK FOR SLIPPERS AND TAKE CARE OF MY WIFE TOO; IS THE DOCTOR THERE, I NEED TO TALK TO HIM!"

In the middle of his rant, I calmly but firmly said, "Sir I need you to stop yelling at me and calm down; I can't help you if you continue to raise your voice because I will be terminating this conversation; do you hear me sir? I need you to lower your voice right now and tell me that you understand"

The Talker rarely hears me use my Command Voice; he raised an eyebrow.
Meanwhile, the agitated old may continues to scream through my Noise Abatement Procedure.

Big sigh. "OK. I'm not yelling. My wife lost her slippers between there and the Mother Ship. I got a call from someone telling me I could pick them up at the front desk. I don't know which front desk, if it's at the hospital, or there, or at the ambulance. Can you find out"

"Sure, give my your phone number and I will try to find out. I can tell you that the slippers are not here (because I put the phone down and looked in the dirty utility room while you were busy trying to blow an aneurysm). I will call you soon"
I took down his number and called the ER at the Mother Ship.

I spoke to Katelyn, who went through the motions and was not very helpful, but she didn't have the slippers either. She said she would look out for them, though.

30 minutes later, I got a phone call from the Missus of Agitated Husband. She very calmly told me the same story. I explained that they were not in my department, nor were they located in the ER downtown. I gave her Katelyn's name and number though, because payback is a bitch.

ANOTHER 30 minutes later, Agitated Husband came to the ER and started yelling at Ellen. As always, trying to protect Ellen, I jumped up and ran around to the front desk; Julie was already on it. She takes no shit from anyone, but does it in a nice way. She told him to sit in the waiting room while she investigated, but he insisted on sitting at her desk.

Now I am all about helping people out, but come on; slippers? What is it with these slippers? What could possibly cause such angst? What the hell, are they the original Ruby Slippers? Diamond encrusted? Made of cats? Mink? Sheesh, take a chill.

By now I was bored with the whole ridiculous scenario so I took $10 out of my wallet, prepared to give it to the guy to buy the wife a new pair of blue fuzzy slippers to replace the old, worn out, filthy, stinky, cat hair laden, piss sodden slippers.

Julie, meanwhile, discovers an important piece of information that both the patient and Agitated Husband neglected to tell me; that the patient was admitted to the hospital as an inpatient FOUR DAYS AGO; her slippers are at the front desk on the 4th floor.

"Oh", says Agitated Husband, now mollified. "I'm not driving down there today".

The Bitch Box...Take a Number

2011-03-23T18:10:00.001-04:00

For some reason, our CEO of less than a year thought it was a good idea to have a suggestion board on the hospital intranet web page. It is pretty entertaining; it is actually more of a bitch board. I am not sure what the educational level is of most of the individuals who post, but let's just say the spelling and grammar are not a priority. Neither is respectful, well thought out posting. Mostly it is about whining. I read it every day because eventually, the Clipboard Peeps are going to get tired of disrespectful and frivolous whining and pull the plug. For example:

"During the day the macaroni and cheese is $3.00 for a large scoop and $1.50 for a small scoop. The other evening I only wanted a little, so I took a small scoop. I was charged $3.00. When I pointed out to the cashier that the sign said it was less for a small scoop, she said it was $3.00 no matter how much you took! This is unfair; it should be a consistent price for both lunch and dinner!"

The food services manager replied that it was all a misunderstanding (yeah, a $1.50 misunderstanding in the cashier's pocket), that the evening cashier had been spoken to and that if the individual would present herself to the cafeteria she would get a refund and a free meal voucher. Score! One of the easier problems to solve.

Someone (and I have my suspicions) from our own ER wrote the following:

"I wish that someone would reconsider installing WiFI in our department. We have both outpatients and ER patients, many of whom are here for hours and hours with nothing to do but read a bunch of old National Geographics and watch a dinky old TV. This is unacceptable and crappy customer service. Since we are required to have closed captioning, the TV is so old that the captioning takes up half the screen. Besides that the TV is on an old rickety table that is a danger to young unruly kidz (actual spelling)and you can only see the TV anyway if you are right in front of it"

The response came from one of the undersecretary Suits in Charge of Stupid Shit:
"We appreciate that your facility is something of a unique entity. While we have not budgeted for the installation of WiFi for this fiscal year, you will be getting a new, larger, wall mounted television in the near future". I call that...not exactly compromise, but we do get something. I hope that the Mother Ship day shift won't be missing ESPN on their cafeteria TV much.

Here's another:
"What is the policy on charge pay? It seems that some of the managers give it out, and some don't. If a manager is on during the day and up to her butt (actually written) in paper work or in meetings with no real understanding of what is going on with the floor, she is not actually managing, now is she? The person who is dealing with the day to day, admissions, and generally overseeing of the floor should be compensated for taking on the added responsibility"

Of course the Head Cheese, that is, the Big Stinky Cheese, wanted name, rank and serial number of the complainant. No resolution that I can see, since most of the managers (who haven't been fired) have been looking for ways to cut, cut, cut. Let's cheat nurses out of charge pay, good idea. Excellent leadership.

This was another nugget of awesomeness:
"How many calories are in the large chocolate chip cookies sold in the lobby coffee shop?"

Seriously?

And because nobody has the balls to say they don't like it, this little gem:
" What is the policy on co-workers peddling their own or their children's or grandchildren's fundaisers? I should not be subjigated to the constant baerage (actual spelling on both) of cookies, candles, wrapping paper or lottery tickets when I come to work".

Douchie complainer was referred to current policy, chapter and verse. And advised to grow a pair and just say no.

One individual, having obviously submitted several complaints on the same issue, the new health insurance provider for the company, was not satisfied with the response:

"Why can't you ever give a straight answer insted (actual spelling) of dancing around the issue? It is extremely frustrating!"

Yeah, we feel your pain.

"Last year there was a new policy that clinical managers would be working two clinical shifts per month; in the last 7 months Floor X has not seen Manager X slinging bedpans, giving meds, or doing any actual nursing tasks that are directly related to patient care. In fact, I have never seen our manager actually touch a patient. How do you respond to this" (Name of manager and floor removed by administrator)

Big Stinky Cheese: "All floor managers have been directed to take an active and participatory clinical role two shifts per month; we feel it is an important leadership activity. We have reinforced with all clinical managers that this is a priority".

In response, I would just like to say:
1. Go Greyhound! Don't know if it is just this manager, but I doubt it.
2. "Activity"??!! WTF.

More later.

Today's Last Patient of the Night

2011-03-20T00:36:00.001-04:00

When we have been patient-free for the last 2 hours of the shift, the final 10 minutes before we release the crocs into the moat, pull up the drawbridge and lock the castle can be stressful. We lock the various cabinets, restock what needs to be restocked, and watch the camera.

Sure enough, at 10:5o someone pulls into the parking lot.

Sigh. Hopefully it is something quick; the doors may lock at 11 PM, but the empathy shuts off at 10 PM.

It is an annoying child with a really annoying father. The father decides that the most important thing on his agenda upon entering the department is taking a piss. I decide to interview the kid; she appeared to be anywhere between 11 and 13.

Reason for visit: "My ear is swollen".

Hmmm. It appears the kid had gotten her ears pierced 6 days before and had a swollen ear lobe for 2 days. NOW it's an emergency. Not.

The father was back, so the kid I ignored since she had a steady stream of verbal diarrhea going: "What are you going to do? Will you have to take out the earring? What will happen to the hole? Will it hurt? Will I need stitches? Why is the sky blue? Do you have any chocolate?"
This, apparently, is the second time the girl had gotten an infection in a freshly pierced ear lobe.

Annoying child had fat earlobes to begin with, just the kind that don't do well with the standard sized pierced ear studs; what she needed was some kind of hoop. Or much longer studs. Or not to pierce her ears at all.

Cripes already had his jacket on and one foot out the door when I told him he had another patient. "Not abdominal pain....something pretty quick", I said to him as he looked crestfallen after a 16 hour shift.

The first thing this 11 year old did was to PUT HER HANDS OVER BOTH HER EARS. Unacceptable. Annoying father was a big help as you can imagine. Why is it that as we approach closing time the IQ of the patients drops exponentially?

Schedule Crap

2011-03-18T20:41:00.001-04:00

I covered the day shift for Mikki for a few hours today. It was me and SIC, who regaled me with the fascinating tale of her husband's Lasek surgery escapades. As if I needed an inducement to take a nap. Hate getting up for the day shift.

There are boatloads of outpatients during the day but not a whole lotta ER patients; they all wait to come in after 3 PM. One young girl with a probable kidney stone was sent to the Mother Ship for a CT scan. The Talker did some fast work. I had time to do some school work for awhile, albeit half-heartedly.

Jane and SIC are friends; they are neighbors and share religious leanings. They spend a lot of time together even though Jane knows SIC walks all over her; takes over during staff meetings; tries to bully Jane into other stuff like, get this, "I think we all need to wear the same color scrubs; like this teal and blue, and always wear a white lab coat!".

Hahahahahaha! No.

I have one advantage over Jane, though; for some reason, SIC is afraid of me, or afraid of riling me up, or afraid of being on the receiving end of one of my rants, or just afraid of not being one of the cool kids. Which she is not. But I am always pleasant and cordial to her, so I don't know why...oh, bull. Of course I know; she just feels inferior, but to be honest, I am not an ER nurse snob when people are doing the work to the best of their ability. And she is very caing and giving. Are you convinced? Didn't think so. No really, she is a good nurse. I would want her to take care of my family members, it's just that she is lacking in the communication department and thinks she is the boss, hence the name. If she was manager, I would quit because it would be unbearable. And that's all I have to say about that.

Anyway, we got to talking about the schedule, Jane and SIC and I. SIC very cautiously approached a notation on the schedule that I had made for Easter; "available". She really wanted it off, and it was a good thing she asked today because I might have made plans by tomorrow.

"Sure, I'll work it for you; I don't mind, and I don't have any plans. Easter really isn't on the agnostic liturgical calendar". I think that bothered her. A little.

The schedule is usually a bone of contention with some. We are a nursing staff numbering about 10. Almost everyone is flexible when it comes to the schedule, with the possible exception of Kerry; she has little kids and a husband who works evenings in their restaurant, so I certainly don't have a problem with that. That said, there is absolutely no need to have the schedule done FOUR MONTHS in advance. Talk about painting yourself into a corner. New Cathy is famous for "getting the new schedule started" even though I told her she is forbidden to do it more than two months in advance. New Cathy isn't afraid of me, apparently, but from another standpoint it really isn't fair that she gets first pick of the evening shift EVERY MONTH. Jane and I are going to have a little discussion about that. I hate to go that route, but I will if I have to; the day shift take turns on a rotating basis putting down their preferred schedule and I am not above insisting on that if I must.

SIC let it slip that Lisa, a day shifter, has started a schedule (that includes the
4th of July, sheesh!) and has kept it in her bag so as not to enrage me; I thought it was both funny and pathetic, so I left her this note:

"Dear Lisa,

You coward! I know that you have the schedule started and are afraid to post it...SEE ME!!!

Ednurseasauras"

I was kidding of course, Lisa is a good egg; if we worked together all the time we would constantly be in trouble.

The problem is that the schedule for the 4rh of July would open up a huge can of worms. Four of us want part of the first 2 weeks of July off. My name is second on the list after Mikki, who counts every second of time, every fragment of charge pay, and has a persecution complex. She just always thinks there is a conspiracy in which she is being targeted. It's bullshit, of course. She and I actually worked last July 4th. I really don' t care since I need a lot of the month of June of for various social engagements. I can always use July 4th as a bargaining chip, but Mikki had off Christmas week, a week off in February and is going to a conference in May for which she needs time off.

Me? I took a week off at the beginning of December, one day in February, and have been paying in blood for every Sunday off since last September between Mikki, Sherry and SIC who needs practically the month of April off and which I have accomodated.

I am thinking that I will probably be off July 4th.

Happy St. Paddy's Day

2011-03-17T11:48:00.005-04:00

Southern Cathy and I worked St. Patrick's day last year; it was crazy, crazy busy, of course. We never got dinner, a snack or a chance to go the bathroom. We wanted to go to Kerry's for a pint.

Kerry's restaurant usually has a pretty good St. Patrick's day festival; Irish dancers, a band or two and more Guinness than you can shake a shillelagh at.

Of course we were starving when we got there a little before midnight. Kerry was helping out at the bar as she usually does on that holiday; tradition. We were crushed that the kitchen was closed. But hey, Kerry had a back up for us.

"I'll get you some corned beef pizza, you'll love it! I invented the recipe myself"

Eeeuw, I thought. I would rather she put cheese and sauce on a pizza box. I loathe everything about corned beef; the smell, the texture and the especially the taste. Nana made a boiled dinner twice a year, and I made sure to leave the house for that event (something we talked about just this morning). The odor permeated the house and my clothes for days. And to add insult to injury, the leftovers were turned into unappetizing lumps of mystery-meat-like pattys known as corned beef hash. I'm sure it was delicious in its own way, but I ate it with extreme prejudice and completely covered in ketchup. At the time, it was enough to gag a maggot. Nana loves corned beef; she was headed out with her friends to the pub, anxious to listen to Irish music, drink green beer and of course eat boiled dinner. As I said....eeeuw.

Seriously? Corned beef pizza?

We were so hungry we actually liked it. Everything is better with ~~beer~~ a proper pint. Can't wait to get off work, hope you get some of your own!

How to Tell a Lie

2011-03-16T19:32:00.001-04:00

Candace, the day xray tech had an outpatient whom, she said, "was nasty and had attitude". I guess he had asked her if she "saw" anything on his xray, which normally annoys the crap out of her.

Jane, my boss said, "Why don't you tell him you see plenty, but you won't tell him what?"
Candace didn't think it was funny; apparently there are strict rules on what they can tell patients, and she usually tells them "I am not allowed to read xrays; that is the responsibility of the radiologist". I guess a lot of patients just get douchy about it, and blame the tech; perhaps it is all in the way the rebuff is presented.

I suggested a few things Candace could tell patients who wanted to know if she "saw" anything:
1. "I once saw a solar eclipse"
2. "I saw the Sound of Music in the theater when I was 10"
3. "I saw an image of the Holy Family in a grilled cheese sandwich!"
4. "I see dead people?"

Candace doesn't have much of a sense of humor.

Another Seinfeld ER Moment

2011-03-15T22:16:00.008-04:00

So, this guy brings in his 69 year old father with some back pain.

"He fell".

Sonny didn't know anything about his medical history except "High blood pressure, dementia and he got his legs cut off". The only med he knows for sure is oxycodone; for chronic hip and back pain.

The man, I'll call him Buck, has pretty piss-poor short term memory. I get him triaged and into a wheelchair and into the waiting room with sonny to await registration.

Moments later, Ellen comes looking for me.

Ellen: "Did that son leave? This gentleman doesn't even know his address, poor thing. Did he leave a number?".

Me: "Nope. Guess he's gone. No forwarding address, either".

I put Buck into a room and help him get undressed. He has all kinds of information to give me; about how a motor vehicle accident cut off both his legs, but they were able to sew them back on. About how his wife died. About how he doesn't drive anymore. About how he used to be an electrician.

What Buck can't tell me is how he fell or where his useless son went.

Cripes was a little busy tonight. He's been working a lot lately, seems like every other shift I get to work with him. It was a while before he was able to see Buck. By then the useless son has returned

"I had to give the car keys to my fiancee". Really. How...interesting.

Useless son continued to be on his cell phone, in and out of the department. "I had to talk to my fiancee". Really. You actually have a girlfriend?

Shortly thereafter, another call to the fiancee; "I had to tell my fiancee my work schedule". Really. Yawn. Dude, I really don't give a shit.

Useless son doesn't have much of an idea about what actually happened to Dad, which prompted yet another call to....you guessed it..."my fiancee to find out what happened".

What a specimen. "I wonder what happened to my fiancee. I know she's here somewhere. Have you seen my fiancee? Tell my fiancee I'm looking for her. I have lost my fiancee, the poor baby".

Me: Maybe the dingo ate your baby.

Buck was fine except for his useless progeny, who I still can't believe even had a girlfriend, let alone a fiancee. I guess there really is someone for everyone.

Really??!

2011-03-12T00:47:00.004-05:00

I thought I might share with you this nugget attached to my online classroom:

Tsunami Warning

At this time, although the tsunami conditions are continuing to be monitored, classes will proceed as normal.

Ok. Just to clarify:
1. The events in Japan are horrific and mind boggling; what does that have to do with a school located on the East Coast. Of the United States.
2. It is unlikely that the online environment will be affected, unless they want to blame tsunami on last week's electronic screwing over of a vast number of students due to non-existent "financial problem".

Seriously?

Nice Day, Nice for Some

2011-03-09T08:38:00.003-05:00

A very nice day brings out the kid in people I guess. It also brings out the douche mongers, like this guy:

He dragged himself with a very high degree of drama (missing only the audio, which was "Oh, woe is me!!! Woe is me!!!) into the triage area ever so slowly before plopping into the chair breathlessly. Wife started doing the talking until I shut her up.

"I fell. In Rite Aid parking lot on ICE! Can you believe they don't do anything about ice in the parking lot of a pharmacy where sick and injured patients need to walk?? It's a travesty!!!"

(um, no, I can't imagine. it makes no sense. it is New Hampshire, one of the coldest and snowiest winters on record where there remains no place to put the snow and SHOCKER, here, there is ice. Just so you know, we have had similar falls and insignificant injuries from a number of equally tort-minded, upstanding, non-working, disability-having, suck -the- life-out-of-the-system douchebags such as yourself).

Me: " Yup. Did you take any pain relievers, elevate or use ice?"

DB: "No, we came right over!"

Me: "I see.
And what is it that you've hurt today?"

DB: "My head, shoulder, wrist, elbow, hand, little finger, hip, knee, ankle and foot"

Me: "Did you hit your head?"

DB: "No! it just missed the bumper of the car! But now I have a migraine!"

Me: (completely losing interest). "Well, you've certainly had an eventful last 8 minutes"
(that was sarcasm, but I bet you knew that; he didn't)
help. police. murder.

This was the first patient of the evening and my eyes are already rolling out of my head.

The day shift, Kelly and Lisa, are finishing up what was not a good day with Gil. They think he orders too many tests and gets all up in people's business unnecessarily. Maybe he does, but they're not going to change him so I just go with it, expect to be busy and make a lot of phone calls on his behalf and no schoolwork done. I like the guy; he's smart and funny and totally gets my sense of humor. Things get done; it's not time to panic 'til it's time to panic. I like that.

I'd much rather work with Gil than Parvati who wants to put an IV in every chronic paineur and drug-seeker and give them Dilaudid; that gets really old, really fast. Her cultural "sky is falling" affect sometimes annoys the crap out of me. I frequently wait until she barks 10 orders at me (at least 5 of them conflicting or redundant) and then just list them back. She changes her mind often, but doesn't always share. ALSO WHEN SHE TALKS IT IS LIKE IT IS ALL IN CAPITALS WITH AN EXCLAMATION POINT! I JUST CAN'T GET THAT EXCITED! A FOLEY CATH IN A PATIENT WITH AN 02 SAT OF 85% IS NOT THE PRIORITY!

The other day a lady came in with "atrial fibrillation". At least, that's what she thought it was; "it's never been documented", she said. "Well", I said to her, "it has now." It was supraventricular tachycardia, or SVT

In a couple of minutes Mikki and I had set the patient up with an IV; she was monitored, on O2 and the EKG was in my hand. I walked into the room next door where Parvati was telling the patient about her daughter's wedding and wordlessly handed it to her.

Parvati came in like Chicken Little ("the sky is falling! the sky is falling!").
She had a few words with the patient and did a cursory exam, then told us "LET'S GIVE SOME CARDIZEM!!"
Me: " I have 6mg of Adenosine ready to go unless you prefer Cardizem; perhaps I missed a really fast atrial fib?" (I never believed it for a minute; I know my SVT)
Parvati: "NO! YOU ARE RIGHT! YES! YES! LET'S GIVE 6 MG OF ADENOSINE! IT HAS TO BE GIVEN FAST!"

Sigh. I know. She is a little wearing, but kind to the patients. And she does dental blocks, so that is kind of fun. We see fewer dental paineurs when she is on.

Anyway, remember the whiny gone-to-ground douchetard in triage? I parked him at the registration desk, and a young man comes in swathed with what looks like several slings and a couch cushion; he is being lead by his Dad who was wearing ski boots. The nearest ski area is at least 30 minutes away.

I waved them directly into a treatment room, which didn't go over well with the douchetard based on the pained expression he shot me.

Long story short; the kid had a fracture/dislocation of his shoulder. Nice kid, nice family. The dad shook my hand about 90 minutes later on their way out, with pain relief, xrays, reduction and follow-up accomplished; he thanked us for taking care of them so quickly. It was the first of two shoulder fractures and one really nasty tibia fracture, 3 admissions and two transfers.

The tibia fracture was Cripe's fav patent of the night. In answer to the question "How did you hurt yourself"came the following responses:
1. "I fell down the stairs. I had a few beers."
2. "I fell off a stool, I was just sitting on it; I had a couple of six packs".
3. "I was just dancing around to reggae music; I've been drinking all day, I think I killed close to a case".

He was admitted for surgery, poor guy. I felt bad because he was also having some social issues (no, really?) centered around his choice of roommates. Whose name he didn't know. Who refused to leave. And who apparently was not paying him rent (although he WAS paying in beer. Not an ideal arrangement).

So, by now I'm sure you're DYING to know how many fractures the douchetard had sustained, how long in traction, how many days out of work, etc, etc, etc.?

Not. One. But Cripes gave him a single Percocet to make up for his long wait while we took care of the young man's shoulder. Him so good!

Please, Just Read the Sign!

2011-03-07T13:53:00.002-05:00

Worked with Cripes last night, always a treat. Stuff gets done, people are seen quickly, and he's a hoot to work with. But still, it was busy not only in the ER, but for all of the outpatient crap as well.

Because of a call-out we only had one secretary to register the boat-load of both out-patients and ER patients. None of which had any actual emergent condition:
Flu-like symptoms, seen yesterday by PCP; not magically better
Sore throat, seen yesterday by PCP; not magically better.
Dental pain
Dental pain
Chronic abdominal pain, nausea and vomiting, "I have a bowel obstruction"; 3 visits in last week, one hospital admission, abusing laxatives and enemas, taking oxy's.
And, same guy:
NO evidence of bowel obstruction and refuses CT scan.
On Medicare which won't pay for Zofran which is what he comes in for.
Does NOT want pain meds.
Wants surgery and "can't find" a surgeon.
Talks continuously about surgery and insists, insists, insists it is the last thing he wants. Suspect Munchausen, which we won't be fixing this in the ER.

The sign-in list is for out-patients, not ER patients. Nobody ever reads the signs. At least once (maybe 5 or 6 times if we are really busy and people are inordinately stupid) a day someone signs in when they should be an ER patient.

Mary, trying to be helpful, waded into the mass of humanity in the waiting room to ask if anyone had any xray orders.

She discovered that an ER patient with some completely non-emergent problem (that had now missed their pediatrician's appointment, haha) had been waiting an hour for registration. Mary got right on her high horse, adamant that the signage was not clear.

Me: "Mary, the signs are crystal clear; the douchtards just don't take the time to read them".
Mary: "My daughter signed in and waited and she needed to be seen in the ER"
Me: "Mary, your daughter is an engineer; clearly she didn't read the sign".
Mary: "Yes she did, she thought she was an outpatient".
Me: " It VERY CLEARLY states what comprises outpatient status, lab, x-ray, mammo, etc".
Mary: "Well, it says those things in small letters written beside it"
Me: "This is a pointless argument; I am going to draw circles on this paper and ignore you until you go away".

I wrote up another sign.

If nothing else, it will keep people busy. I don't see any loopholes or inconsistancies, do you?

Sunday Funnies (not)

2011-03-06T10:17:00.026-05:00

I am beyond pissed.
I have been shut out of, and apparently withdrawn from, my online course Holistic Professional Nursing (which, stupidly, is recycled public health nursing; same book, same instructor). Without warning. For an alleged financial deficit.

This is my last course. I have been taking courses for almost 4 years and have always paid IN CASH. There is no extra work on the part of the university to scrape money from the government or others who are reluctant to pay their bills; I have not been forced to sell my kidney (yet). I have managed to keep it going. I don't even do FAFSA forms. My financial interview went something like this:

Accountant: How do you intend to pay? Will you be taking out loans, applying for scholarships, reimbursement from an employer, state grant, selling a child or any of your internal organs?

Me: Cash

Accountant: Oh, I see. Do you need a payment plan? We could work out a monthly draw from your checking account or a credit card...

Me: I'll make it simple. You tell me how much I owe per class. Then I'll pay it. Does that work?

I have been paid up in full with a zero balance for two weeks. Since my final course was a bit of an ambush, the course was only partially paid; but it was a weekend, and my payment posted a few days later. That was two weeks ago.

My instructor says I am withdrawn from the roster; she had no notification, but said she would work with me once I straightened it out. Of course, there is NOBODY working weekends anywhere in the college. I can't even get a human being on the phone except for tech support, and they are useless. Even for tech issues. No, they don't know the name of the administrator on call.

I spoke to my advisor on Friday before this happened and she sent the forms for graduation. In June. In Savannah. As I understand it, I must have a zero balance on account before that information can even be sent out to the graduate. Two days later, I am still looking forlornly at my account with a ZERO BALANCE while I ~~mourn my 4.0 course GPA~~ grow anxious about the work I can't do since my instructor ignored the part of my email about forwarding the grading rubric. I just don't want to restart this course at the end of the month because some illiterate hamster pushed the wrong button then went home for the weekend, la la la.

As a sacred cash cow, I certainly expected better treatment.
Someone's gonna get an earful tomorrow.

But today, I am doing something much more fun; the taxes! Yes, just go ahead and kick me while I'm down. Annually, I would rather have hot sharp steel needles poked in both my eyes than do the taxes. I get extraordinarily pissy; Mr. Ednurseasauras generally starts sending out feelers in January to get me used to the idea gradually:
"So....with your schedule, I'm thinking that January nearly gone, and your skating trip and studies, February is not a good month for taxes?" (walking on eggshells)
Me: "Let me get a couple of weeks of this course going, then we can look at them".

Now, the requests become more specific:
"So....you're off this weekend?"
Me: "Yup. I am taking a salsa dance class with Southern Cathy on Saturday then going to the mall to buy granny underwear"
Mr. Ednurseasauras: "Um, okay, yeah (misses the granny underwear reference). How do you feel about looking at the taxes on Sunday?" (ducks behind the couch with the dog in case I decide to throw my coffee cup)
Me: "Well. Ok, but it will end badly, you know it does. We have to do something fun later to make up for it".
Mr. Ednurseasauras: "OK, sure. Whatever you want"
Me: "I really want to go bowling" (I don't, really. I'm just messing with him)
Mr. Ednurseasauras: "I will get stuff organized then". This requires that reams and reams of paper come out and are stacked in organized piles around the living room. Out comes the file box; Mr. Edn mutters, makes notes, gets up to look for something, comes back with another document, makes a phone call. This goes on for a while. In the meantime, Meet the Press (a show which just really sets my teeth on edge) is on, and Mr. Edn occasionally looks up to follow what's going on. Me? I am surfing the web on my laptop, on Facebook and blogging. There is no schoolwork to do, so I'm doing the academic equivalent of nothing.

Me: (after about an hour) "How are we doing over there?"
Mr. Ednurseasauras: (muttering and shuffling) "Alright"
Me: Sigh. "Should I take the dog out?"
Mr. Ednurseasauras: "I need about another 10 minutes of mutter, mutter, grumble, then I should be done"

Then the fun should begin.

Me: "What's all the ruckus about? Aren't you just organizing stuff?"
Mr. Ednurseasauras: "It's the bank interest, it's not totaled. And if you don't have that marked down on the tax form, the bank interest, it gets shot down. all that for a total of.....(consults calculator), $2.25. Between the two banks"
Me: "Couldn't we just make it up?"
Mr. EDn: "I don't think so".
************************************************************************************
2 1/2 hours later and the taxes are, mercifully, done. Nobody has died, except maybe Tina out of pure boredom, or even sustained injury from flying coffee cups. Eerily civilized I must say. Even his Massachusetts state taxes which are enormously painful and usually requires an accounting degree to figure out; no wonder Mass. is in such dire straits and the economy sucks so bad. I read Mr. Edn my rantings from earlier and he is mildly amused.
Mr. Edn: "How often do you write stuff about me? What are you typing, everything I say?"
Me: "Hold on....(typing)...'everything I say?'....what?, no, I'm just writing random stuff about how you kicked the file box across the room"
Mr. Edn: "What? I did not! You really do make this stuff up!"
Me: "Just enough to protect the innocent".
Mr. Ednurseasauras ever so lightly kicked the file box.
Me: "OK, well I guess I'll just do something really fun now, like the laundry so the day isn't entirely wasted".

Not today...but someday

2011-03-05T19:04:00.007-05:00

New Cathy and I heard the call go out on the scanner for a 48 year old female; CPR in progress. We waited for the radio transmission from the field, fully expecting that the code would be brought our way.

It came: 3 rounds of drugs, intubated, EJ blown but a working IO.

"We'll be a little bit yet; we are still working on extrication"

What!!??? Extrication!!??? No, it couldn't be. Cathy and I stared at each other in mute horror.

I grabbed the phone and punched in dispatch.

"What's the address of that code??"

Not Elm St.

He said....What??

2011-03-03T20:04:00.003-05:00

Southern Cathy: I can't believe you didn't filet that guy for saying that. I have never seen you so calm when someone is rude to you; are you on new happy pills or something?
Me: Hmm, what? I was taking his blood pressure, I didn't hear a thing. OK, what was it he said then?
Southern Cathy: (turning pale) I, umm... well, what I mean to say is.....well....he said....
Me: Spit it out!
Southern Cathy: He said...."IN ANOTHER MINUTE I'LL BE MAKING LOVE WITH THIS NICE NURSE"! Sorry! I though you heard it, jeesh, if I'd known you hadn't I never would have mentioned it!
Me: Cath, he's 80 fucking years old; at most he would get an over-the-top-of-the-glasses stare. Get a grip.

Nursing...the Next Generation

2011-02-23T22:34:00.002-05:00

For some reason, there are more than a few nursing students who feel the need to read this blog. That's OK, as long as y'all are taking my mad ranting with a grain of salt. Remember that I have been a nurse for a long time. A VERY long time. During that time I have run the gamut from wide-eyed optimist, to rebel without a clue, to union organizer, to leader, to simply throwing my hands up in surrender. Butcher, baker, candlestick maker. I've done....well, not quite everything but near enough. Near enough.

Although I love to teach and am usually on my best behavior when I am toting a student around like a pull toy, I usually have to make a conscious effort not to make snarky comments. Also to conduct myself professionally and to set a good example. It is stressful. I can usually go about 2 to 3 hours before I go off on something or other. Just can't help it.

Tonight I had a student for 6 ~~painful~~ wonderful hours. I was a paragon of virtue for the first 2; shocker.

A satellite ER is not the greatest place to have a first year student. For one thing, we have limited resources on a number of levels; we don't do things exactly by the book, and it is an entirely different environment. Plus, when things rapidly go to hell in a hand basket, it is necessary for students to just get the hell out of the way and for me to try to explain later. Sometimes we just can't use the training wheels, and students are forbidden to ride the bike without them.

Since we can't even let students take vital signs (only second year students can do that, yikes) I hauled my student to triage and back, in and out of rooms for IV starts, and had her hand me stuff. No big deal. I think it was more important to give her a sense of how the assessment process works, but you know kids; not happy unless they have a toy to play with. I had a high school intern who was bored out of her mind last fall, and mainly did her English homework if it was quiet. On her evaluation, you know what she listed as the best part of the entire 100 hours? "Ednurseasauras showed me how to use a syringe and needle to draw up water (saline, actually), and how to get rid of the bubbles". She played with it for about 2 hours.

Really? The best thing you did in weeks?

Tonight I had a good bit of time to explain stuff which makes for a reasonably good experience. I showed her all of our toys "Oooh! Shiny!". I let her listen to lung sounds. I showed her how to take out sutures. She had some initiative and was out of the chair when patients came in to accompany New Cathy and I to triage. I only went off on one of the 3 frequent narcotic seekers who was pissed that she got Tramadol, and even more pissed when Bobo gave her a 'script for Motrin when she complained. But I digress. Mostly I was a good little nurse.

Now that you have finished falling off your chair, you may resume your normal activities.

Oh, when I asked the student what were the best/worst parts of her experience at night's end, she thought that making the beds was the worst part.

Hmmmm....