Thursday, November 29, 2007

Supersize Me

The official start of the holiday season brings a week for caring for the morbidly obese. Now, I have no problem with people unless they refuse to take any responsibility for themselves, but I'm frankly getting tired of spending a lot of effort stepping around people's motorized scooters because they are so overweight they can't walk.

One guy (no scooter) weighing in at over 300 pounds presented with increased urination and insatiable thirst for about a week. To nobody's surprise his blood glucose was 620. I was kind of worried about this guy because all he could think about was going home to eat the cheesecake his wife had made. Sheesh! Guy, you are a walking heart attack and a stroke waiting to happen.

Supersized contestant number two was a woman weighing in at over 400 pounds who comes in by ambulance (EMS, you are my heroes) with an ankle injury one day after sustaining a fall in which she broke her proximal humerus. Truly, I don't know how this individual functions. She was clearly hygienically challenged. Her ankle was merely sprained, but a family member wanted her admitted. WTF! Don't you love how the family members are all over the patient in the ER, but when it comes down to taking care of the patient at home they trip over each other heading for the hills. I had PT do a safety evaluation and she failed because 1) the patient lives in a 2nd floor apartment, 2) the family had REMOVED THE BANNISTERS AND THROWN THEM AWAY TO GET FURNITURE UP THE STAIRS, which means, 3) she couldn't safely or QUICKLY leave the apartment in case of an emergency (!). Are you kidding? That woman had no prayer of leaving that apartment quickly for the last 10 years with 4 good limbs and wings. Yikes. The bottom line is that the patient gets admitted so someone else can take care of her. But the family drove her, I'm sure out of the goodness of their hearts.

Monday, November 26, 2007

The ER Waiting Room: Too Many Squeaky Wheels

It is at Triage that many of the problems dealing with the public begin.

Not understanding or caring that the ER is not Burger King where one may very well not have it their way, the triage process is of little importance to the patient who insists that his problem is worse than anyone else’s. The consequences of the “squeaky wheel” mentality on a waiting room full of frustrated, anxious, sick, and angry patients can best be described by envisioning the abandon ship scene in the movie, “Titanic”.

As the boats are filled with women and children (think of these as the really sick people), the men (people who are not as sick, have chronic conditions, and are well enough to sit in the waiting room for hours) are left on deck hoping for rescue and singing “Nearer my God to Thee” while the stewards put out more deck chairs. Much as these patients believe it, however, the ER waiting room will not sink; this means it is pointless to storm the triage nurse to explain how badly one needs to be seen as soon as possible (consider this clamoring for a spot on the stern of the ship). Eventually, there will be a boat for everyone, even it is takes 6 hours. If a patient is likely to require a kidney transplant by then,he/she will be seen sooner. Otherwise, the waiting area is a little like Disney World: just when you think you are getting in, there is another 2 hour wait before you actually get on the ride. Alas, there is no "baby swap", and sending your 7 year old to inquire for the fifth time in 20 minutes how much longer it will be just wont' fly. And it doesn't matter if you have another appointment, dinner reservations, a meeting with your parole officer (pimp, ex-boyfriend, drug dealer, your child's teacher, life coach). Remember, patience is a virtue.

Saturday, November 24, 2007

Day After Thanksgiving

I usually work the evening shift, I just like it better. There are generally fewer suits to mess with and you can do your own thing. The only problem is that when the ED Nurse Suit goes home at 4 PM, there is the problem of poor staffing, no techs, and no paramedics. Oh, and no transport. It is not ok to leave the shift with the highest volume of patients without adequate means to provide for the hordes, especially the day after Thanksgiving when the PCP offices are closed. I was quite pleased, in an evil sort of way, to hear that the day shift was so busy "we could only sit for about an hour!" Oh, really. Pardon my sarcasm, so sorry you couldn't enjoy the entire paper AND your latte.

Well, my day after Thanksgiving was something to be thankful for. I had nice, normal, appreciative patients. I really felt like I did something good today, even if it was nothing more than being able to REALLY do some patient teaching, make someone actually feel better, help my colleagues and take a bathroom break before ascites set in. Whoo hoo!

Tuesday, November 20, 2007

All Aboard the Toradol Express!!!

I wish I had a nickel for every time I have heard, "You have my records" (sorry, I don't, and I'm not interested enough to go look for it), "I take that little blue pill for my high blood pressure, don't you know what it is?" (nope, it's one of thousands) "My doctor knows what I take"(yes, but your doctor pawned you off on the ER, now, didn't he?). I bet the average ER nurse spends at least 1/3 of a shift doing what patient's should be responsible for. I feel bad for the pharmacists who have to take calls from us to verify a patient's meds because they were too lazy to write them down. Come on, people, it takes 30 seconds. And if you don't know what you are taking and what it's for, you probably shouldn't be taking it.

Don't get me started on the drug seekers. Tonight we had an impressive attendance of the "Better Living Through Chemistry" Club. Everyone got a shot of Toradol. I admonished the doc that we only had a limited supply even though IT IS A MIRACLE CURE. The woman who came in cradling her shoulder with 10/10 pain had no trouble lifting it to give an obscene gesture on the way out. And that guy with the hip pain who limped in had such a spring in his step as he slammed out that door (probably on the way to the other hospitalin town. Guess they didn't get the memo that Dr. Nonarcs was on duty.

Saturday, November 17, 2007

Having a family member become a hospital patient really makes you think about your own practice. My physically active husband returned from a pre-op appointment for elective shoulder surgery with symptom-free "changes in my EKG" and was turfed to his cardiologist. Another EKG, an Echo, and next thing you know, he's headed for the cath lab. While on the table (and after finding a couple of significant occlusions) he now has a choice of the metal stent or the medicated stent. Choice A means ASA and Plavix for a few months. Choice B means ASA and Plavix for over a year, and by the way you can forget about that shoulder surgery. Since I happened to have a friend who worked in the cath lab, she drags me back to help my husband with this decision. This is a problem considering he is one takes 3 trips to the store to decide on a pair of jeans. I will say the interventionalist was VERY patient with him; decision made, medicated stent.

In the ICU, Jane, his nurse, seemed to understand my husband's "what the hell just happened here", deer-in-the-headlights look and promptly got him some Ativan. She patiently answered all of my husband's questions and got him settled in. She signed out to Leslie at change of shift, who handled my husband beautifully with the right mix of humor, authority and caring. My husband had some leaking around clip in the artery, so in comes the Resident Twins. This is an equal opportunity teaching hospital, so they neither speak English nor posess people skills. Oh, and they travel in pairs for added fun. I refused to leave until I made Leslie promise that she would turn my husband over to someone more than competent at change of shift, and keep Frick and Frack away from the patient.

I picked husband up at noon the following day and all was well. He is home now, testing me at every turn, angry that he can't have his surgery and not yet grasping that the ticking time bomb in his chest has been defused. A little perspective is useful.